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Kasper S, Cubała WJ, Fagiolini A, Ramos-Quiroga JA, Souery D, Young AH. Practical recommendations for the management of treatment-resistant depression with esketamine nasal spray therapy: Basic science, evidence-based knowledge and expert guidance. World J Biol Psychiatry 2021; 22:468-482. [PMID: 33138665 DOI: 10.1080/15622975.2020.1836399] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Despite the available therapies for treatment-resistant depression (TRD), there are a limited number that are evidence-based and effective in this hard-to-treat population. Esketamine nasal spray, an intranasal N-methyl-d-aspartate (NMDA) glutamate receptor antagonist, is a novel, fast-acting option in this patient population. This manuscript provides expert guidance on the practicalities of using esketamine nasal spray. METHODS A group of six European experts in major depressive disorder (MDD) and TRD, with clinical experience of treating patients with esketamine nasal spray, first generated practical recommendations, before editing and voting on these to develop consensus statements during an online meeting. RESULTS The final consensus statements encompass not only pre-treatment considerations for patients with TRD, but also specific guidelines for clinicians to consider during and post-administration of esketamine nasal spray. CONCLUSIONS Esketamine nasal spray is a novel, fast-acting agent that provides an additional treatment option for patients with TRD who have previously failed several therapies. The guidance here is based on the authors' experience and the available literature; however, further real-world use of esketamine nasal spray will add to existing knowledge. The recommendations offer practical guidance to clinicians who are unfamiliar with esketamine nasal spray.
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Affiliation(s)
- Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Wiesław J Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Josep A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Souery
- European Centre of Psychological Medicine, Psy Pluriel, Brussels, Belgium
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
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Hogg B, Medina JC, Gardoki-Souto I, Serbanescu I, Moreno-Alcázar A, Cerga-Pashoja A, Coppens E, Tóth MD, Fanaj N, Greiner BA, Holland C, Kõlves K, Maxwell M, Qirjako G, de Winter L, Hegerl U, Pérez-Sola V, Arensman E, Amann BL. Workplace interventions to reduce depression and anxiety in small and medium-sized enterprises: A systematic review. J Affect Disord 2021; 290:378-386. [PMID: 34082284 DOI: 10.1016/j.jad.2021.04.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/14/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are the most prevalent mental health difficulties in the workplace, costing the global economy $1 trillion each year. Evidence indicates that symptoms may be reduced by interventions in the workplace. This paper is the first to systematically review psychosocial interventions for depression, anxiety, and suicidal ideation and behaviours in small-to medium-size enterprises (SMEs). METHODS A systematic search following PRISMA guidelines, registered in PROSPERO (CRD42020156275), was conducted for psychosocial interventions targeting depression, anxiety, and suicidal ideation/behaviour in SMEs. The PubMed, PsycINFO, Scopus, and two specific occupational health databases were searched, as well as four databases for grey literature, without time limit until 2nd December 2019. RESULTS In total, 1283 records were identified, 70 were retained for full-text screening, and seven met the inclusion criteria: three randomised controlled trials (RCTs), three before and after designs and one non-randomised trial, comprising 5111 participants. Study quality was low to moderate according to the Quality Assessment Tool for Quantitative Studies. Five studies showed a reduction in depression and anxiety symptoms using techniques based on cognitive behavioural therapy (CBT), two reported no significant change. LIMITATIONS Low number and high heterogeneity of interventions and outcomes, high attrition and lack of rigorous RCTs. CONCLUSIONS Preliminary evidence indicates CBT-based interventions can be effective in targeting symptoms of depression and anxiety in SME employees. There may be unique challenges to implementing programmes in SMEs. Further research is needed in this important area.
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Affiliation(s)
- Bridget Hogg
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; PhD Programme, Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Carles Medina
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; PhD Programme, Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilinca Serbanescu
- European Alliance Against Depression e.V., Leipzig, Germany; Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arlinda Cerga-Pashoja
- Population Health, London School of Hygiene and Tropical Medicine, London, England; Global Public Health, Public Health England, United Kingdom
| | - Evelien Coppens
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Belgium
| | - Mónika Ditta Tóth
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | | | - Birgit A Greiner
- School of Public Health, College of Medicine and Health, National Suicide Research Foundation, University College Cork, Ireland
| | - Carolyn Holland
- National Suicide Research Foundation, Cork, Ireland; Health Service Executive, Cork, Ireland
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, United Kingdom
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Lars de Winter
- Phrenos Center of Expertise for severe mental illness, Utrecht, the Netherlands
| | - Ulrich Hegerl
- European Alliance Against Depression e.V., Leipzig, Germany; Research Centre of the German Depression Foundation, Leipzig, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Victor Pérez-Sola
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, National Suicide Research Foundation, University College Cork, Ireland; National Suicide Research Foundation, Cork, Ireland; Australian Institute for Suicide Research and Prevention, Griffith University; International Association for Suicide Prevention (IASP), Washington DC, USA.
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
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153
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Li S, Cao W, Zhou S, Ma M, Zhang W, Li F, Li C. Expression of Cntn1 is regulated by stress and associated with anxiety and depression phenotypes. Brain Behav Immun 2021; 95:142-153. [PMID: 33737174 DOI: 10.1016/j.bbi.2021.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
In recent years, our understanding of neural circuits associated with depression has increased. Although inherited factors are known to influence individual differences in the risk for this disorder, it has been difficult to identify specific genes that moderate circuit functions affecting depression. Genome-wide association studies have identified genetic variants of Cntn1 that are linked to major depressive disorders. Cntn1, a subset of the neural cell adhesion protein and immunoglobulin supergene family, participates in cell contact formation and axonal growth control and plays a role in degenerative and inflammatory disorders. However, neuronal substrates that mediate Cntn1 action on depression-like phenotypes and involved mechanisms are unclear. Here, we exploited chronic unpredictable stress (CUS) exposure and found that CUS treatment significantly increased hippocampal Cntn1 messenger RNA and protein expression in both mice and rats, but not in the medial prefrontal cortex, which presented a region-specific regulation. Using an adeno-associated virus-based approach to directly overexpress Cntn1 via stereotactic injection, we demonstrated that Cntn1 overexpression in the hippocampus triggered anxiety- and depression-like phenotypes in addition to microglia activation or phagocytosis in the hippocampus, resulting in upregulation of pro-inflammatory cytokine (IL1α, IL6, and Ccl2) mRNA expression and downregulation of anti-inflammatory cytokine (IL4 and CD206) mRNA expression, determined using real-time quantitative PCR, thus impairing hippocampal immature neurons in the dentate gyrus, determined using immunohistochemical staining for doublecortin, a specific marker for immature neurons. Collectively, our results identified Cntn1 as a novel risk gene involved in regulating anxiety and depression via functional actions in the hippocampus that is correlated with microglial activation or phagocytosis and reduced hippocampal immature neurons. These results may provide a better understanding of the pathophysiological mechanisms underlying the risk of depression-related disorders.
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Affiliation(s)
- Songji Li
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China
| | - Wenyu Cao
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, Hengyang, Hunan Province 421001, China
| | - Shifen Zhou
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China
| | - Minhui Ma
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China
| | - Wenjuan Zhang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China
| | - Fang Li
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China
| | - Changqi Li
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan Province 410013, China.
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154
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Eggart M, Todd J, Valdés-Stauber J. Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder. PLoS One 2021; 16:e0253913. [PMID: 34170963 PMCID: PMC8232409 DOI: 10.1371/journal.pone.0253913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.
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Affiliation(s)
- Michael Eggart
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
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155
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Weber J, Angerer P, Brenner L, Brezinski J, Chrysanthou S, Erim Y, Feißt M, Hansmann M, Hondong S, Kessemeier FM, Kilian R, Klose C, Köllner V, Kohl F, Krisam R, Kröger C, Sander A, Schröder UB, Stegmann R, Wegewitz U, Gündel H, Rothermund E, Herrmann K. Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project). BMC Public Health 2021; 21:1187. [PMID: 34158017 PMCID: PMC8218449 DOI: 10.1186/s12889-021-11195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. METHODS This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. DISCUSSION Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. TRIAL REGISTRATION The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049 .
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Affiliation(s)
- Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lorena Brenner
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Jolanda Brezinski
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sophia Chrysanthou
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Marieke Hansmann
- Institute of Psychology, University of Hildesheim Foundation, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sinja Hondong
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Franziska Maria Kessemeier
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Reinhold Kilian
- Department Psychiatry II, Section of Health Economics and Psychiatric Services Research, Ulm University, Lindenallee 2, 89312, Günzburg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Volker Köllner
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christoph Kröger
- Institute of Psychology, University of Hildesheim Foundation, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Ute Beate Schröder
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Ralf Stegmann
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Uta Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Kristin Herrmann
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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156
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Weijers A, Rasing S, Creemers D, Vermulst A, Schellekens AFA, Westerhof GJ. The relationship between depressive symptoms, general psychopathology, and well-being in patients with major depressive disorder. J Clin Psychol 2021; 77:1472-1486. [PMID: 33188711 PMCID: PMC8246916 DOI: 10.1002/jclp.23083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE In mental health care, treatment effects are commonly monitored by symptom severity measures. This study aimed to investigate the relationship between symptom severity and well-being in the treatment of patients with major depressive disorder (MDD). METHODS Adult MDD outpatients (n = 77) were administered the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Outcome Questionnaire (OQ-45), and the Mental Health Continuum-Short Form (MHC-SF) before treatment and 6 months later. RESULTS Symptom severity correlated moderately with well-being at baseline and strongly at follow-up. Reliable change index scores showed improvement on the QIDS-SR, OQ-45, and MHC-SF in 65%, 59%, and 40%, respectively. A quarter of patients improved in symptom severity but not well-being (Inventory of Depressive Symptomatology-Self-Report [IDS-SR]: 25%; OQ-45: 24%). CONCLUSION Findings suggest that symptom severity and subjective well-being are related, but distinct concepts. Several reasons for the stronger improvements in symptoms than in well-being are discussed.
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Affiliation(s)
| | - Sanne Rasing
- GGZ Oost BrabantBoekelThe Netherlands
- Behavioral Science InstituteRadboud UniversityNijmegenThe Netherlands
| | - Daan Creemers
- GGZ Oost BrabantBoekelThe Netherlands
- Behavioral Science InstituteRadboud UniversityNijmegenThe Netherlands
| | | | - Arnt F. A. Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Radboud UniversityNijmegenThe Netherlands
| | - Gerben J. Westerhof
- Department Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
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Rabin LA, Miles RT, Kamata A, Krishnan A, Elbulok-Charcape M, Stewart G, Compton MT. Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c). Psychiatry Res 2021; 300:113897. [PMID: 33887516 DOI: 10.1016/j.psychres.2021.113897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 03/20/2021] [Indexed: 11/25/2022]
Abstract
Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.
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Affiliation(s)
- Laura A Rabin
- Brooklyn College of The City University of New York, Department of Psychology, Brooklyn, NY, USA.
| | - Rona T Miles
- Brooklyn College of The City University of New York, Department of Psychology, Brooklyn, NY, USA
| | - Akihito Kamata
- Southern Methodist University, Simmons School of Education and Human Development, Dallas, TX, USA
| | - Anjali Krishnan
- Brooklyn College of The City University of New York, Department of Psychology, Brooklyn, NY, USA
| | | | - Genéa Stewart
- University of North Texas, Department of Educational Psychology, Denton, TX, USA
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158
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Amsalem D, Lazarov A, Markowitz JC, Gorman D, Dixon LB, Neria Y. Increasing treatment-seeking intentions of US veterans in the Covid-19 era: A randomized controlled trial. Depress Anxiety 2021; 38:639-647. [PMID: 33734539 PMCID: PMC8251313 DOI: 10.1002/da.23149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Veterans have higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD), and may be vulnerable to mental health consequences of the Covid-19 pandemic. More than half of veterans who meet mental illness criteria do not seek help. This study screened for clinical symptoms and evaluated the efficacy of a brief, online social-contact-based video intervention in increasing treatment-seeking intentions among veterans. We hypothesized that the video-based intervention would increase treatment-seeking intentions more than written vignette and control conditions. METHODS One hundred seventy-two veterans were randomized to either a (a) brief video-based intervention; (b) written vignette intervention, or (c) nonintervention control group. In the 3-min video, a veteran previously diagnosed with PTSD described his symptom reactivation by Covid-19, his barriers to care, and how therapy helped him to cope. Assessments were conducted at baseline, postintervention, and at 14- and 30-day follow-ups. RESULTS A total of 91 (53%) veterans reported high levels of clinical symptoms, especially those self-reporting Covid-19 exposure. The brief video-based intervention yielded greater increase in treatment-seeking intentions among veterans. Within the video group, women showed an increase in treatment-seeking intentions from baseline to postintervention only, whereas men showed a more sustained effect, from baseline to Day 14. CONCLUSIONS Surveyed veterans reported high symptoms levels. A brief video intervention increased treatment-seeking intention, likely through identification and emotional engagement with the video protagonist. This easily disseminable video-based intervention has the potential to increase likelihood of seeking care. Future research should examine longer term sustainability and changes in help-seeking behavior.
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Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, New York State Psychiatric InstituteColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv UniversityTel AvivIsrael
| | - John C. Markowitz
- Department of Psychiatry, New York State Psychiatric InstituteColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Daniel Gorman
- Department of Psychiatry, New York State Psychiatric InstituteColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Lisa B. Dixon
- Department of Psychiatry, New York State Psychiatric InstituteColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA
| | - Yuval Neria
- Department of Psychiatry, New York State Psychiatric InstituteColumbia University Vagelos College of Physicians & SurgeonsNew YorkNew YorkUSA,Department of EpidemiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
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159
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Matias Nascimento Maia W, Das Chagas Pereira de Andrade F, Alves Filgueiras L, Nogueira Mendes A, Fonseca Costa Assunção A, Davidson Sérvulo Rodrigues N, Brandim Marques R, Luiz Martins Maia Filho A, Pergentino de Sousa D, Da Silva Lopes L. Antidepressant activity of rose oxide essential oil: possible involvement of serotonergic transmission. Heliyon 2021; 7:e06620. [PMID: 33948502 PMCID: PMC8080052 DOI: 10.1016/j.heliyon.2021.e06620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/02/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022] Open
Abstract
Rose oxide (RO) is a monoterpene found in rose oil fragrances. This monoterpene has been reported to possess anti-inflammatory activity, however, little is known regarding its pharmacological activity. The present study was carried out to evaluate its antidepressant action and possible mechanisms of action. Analysis of ADMET pharmacokinetic properties (absorption, distribution, metabolism, excretion and toxicity) of rose oxide was performed by computational prediction analysis. Behavioral tests were performed to assess the interaction between rose oxide and the central nervous system and antidepressant effect that includes: forced swim test (FST), tail suspension test (TST), open field test (OFT) and rota-rod test. The results of pharmacokinetic and toxicological properties indicate that rose oxide could be used orally, since it has good intestinal absorption as well as pharmacological and toxicological properties that can be similar to pharmacological compounds (regular hepatic metabolism and low toxicity). Treatment with 50 mg/kg of rose oxide was able to decrease the immobility time of animals not affected by FST and TST and was not able to alter the motor activity of the OFT and rota-rod test, suggesting modulation and antidepressant activity. Docking data suggest that rose oxide can bind to receptors in the serotonergic pathway. The results described here suggest that rose oxide has antidepressant activity, modulating the serotonergic pathway.
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Affiliation(s)
- Wcleubianne Matias Nascimento Maia
- Postgraduate Programs in Pharmaceutical Sciences and Laboratory of Research in Experimental Neurochemistry (LAPNEX), Federal University of Piauí, 64049-550, Teresina, Brazil
| | - Francisco Das Chagas Pereira de Andrade
- Laboratory of Innovation in Science and Technology, LACITEC, Department of Biophysics and Physiology, Federal University of Piauí, 64049-550, Teresina, Piauí, Brazil
| | - Livia Alves Filgueiras
- Laboratory of Innovation in Science and Technology, LACITEC, Department of Biophysics and Physiology, Federal University of Piauí, 64049-550, Teresina, Piauí, Brazil
| | - Anderson Nogueira Mendes
- Laboratory of Innovation in Science and Technology, LACITEC, Department of Biophysics and Physiology, Federal University of Piauí, 64049-550, Teresina, Piauí, Brazil
| | | | | | - Rosemarie Brandim Marques
- Nucleus of Biotechnology and Biodiversity of the State University of Piauí, 64003-120, Teresina, Piauí, Brazil
| | | | | | - Luciano Da Silva Lopes
- Postgraduate Programs in Pharmaceutical Sciences and Laboratory of Research in Experimental Neurochemistry (LAPNEX), Federal University of Piauí, 64049-550, Teresina, Brazil
- Corresponding author.
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160
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Differential Alterations in Resting State Functional Connectivity Associated with Depressive Symptoms and Early Life Adversity. Brain Sci 2021; 11:brainsci11050591. [PMID: 34063232 PMCID: PMC8147478 DOI: 10.3390/brainsci11050591] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
Depression and early life adversity (ELA) are associated with aberrant resting state functional connectivity (FC) of the default mode (DMN), salience (SN), and central executive networks (CEN). However, the specific and differential associations of depression and ELA with FC of these networks remain unclear. Applying a dimensional approach, here we analyzed associations of FC between major nodes of the DMN, SN, and CEN with severity of depressive symptoms and ELA defined as childhood abuse and neglect in a sample of 83 healthy and depressed subjects. Depressive symptoms were linked to increased FC within the SN and decreased FC of the SN with the DMN and CEN. Childhood abuse was associated with increased FC within the SN, whereas childhood neglect was associated with decreased FC within the SN and increased FC between the SN and the DMN. Our study thus provides evidence for differential associations of depressive symptoms and ELA with resting state FC and contributes to a clarification of previously contradictory findings. Specific FC abnormalities may underlie specific cognitive and emotional impairments. Future research should link specific clinical symptoms resulting from ELA to FC patterns thereby characterizing depression subtypes with specific neurobiological signatures.
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161
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Bartova L, Dold M, Fugger G, Kautzky A, Mitschek MMM, Weidenauer A, Handschuh PA, Frey R, Mandelli L, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. The Role of Relationship Status in Major Depressive Disorder - Results of the European Group for the Study of Resistant Depression. J Affect Disord 2021; 286:149-157. [PMID: 33725614 DOI: 10.1016/j.jad.2021.02.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND While the association between relationship status and the development of depressive symptoms in the general population were reported previously, its relation to the severity and the course of major depressive disorder (MDD) as well as the treatment patterns and response rates needs to be elucidated. METHODS The present international multicenter cross-sectional study performed by the European Group for the Study of Resistant Depression (GSRD) investigated socio-demographic and clinical patterns of relationship status in a real-world sample of 1410 adult in- and outpatients with MDD as primary diagnosis. RESULTS While 49.9% of all MDD patients were partnered, 25.4% were separated, and 24.8% were single. Single relationship status was linked to younger mean age, earlier mean age of onset, and current suicidal risk. Being separated was related to older mean age, unemployment, greater symptom severity, current suicidal risk, and add-on treatment strategies. Partnered relationship status was associated with less frequent current suicidal risk. LIMITATIONS The retrospective assessment of treatment response that was exclusively based on psychopharmacotherapeutic strategies should be critically considered and weighed while interpreting the present results providing novel insights into the complex interaction of relationship status with the clinical phenotype of MDD. CONCLUSIONS Although MDD patients living in relationships do not seem to be omitted from the evolution of MDD, they may be spared from chronicity and suicidality. Hence, being aware of the current relationship status might support clinicians in the diagnostic and therapeutic process towards optimized management of such challenging clinical phenomena and their negative consequences.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Laura Mandelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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162
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Arnaud A, Suthoff E, Stenson K, Werneburg B, Hodgkins P, Bonthapally V, Jonas J, Meyer K, O'Day K. Number Needed to Treat and Number Needed to Harm analysis of the zuranolone phase 2 clinical trial results in major depressive disorder. J Affect Disord 2021; 285:112-119. [PMID: 33640861 DOI: 10.1016/j.jad.2021.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Zuranolone (SAGE-217) is a novel, investigational positive allosteric modulator of GABAA receptors being investigated in major depressive disorder (MDD). This analysis of phase 2 data quantified the benefit and risk of zuranolone (30mg) versus placebo and antidepressants in terms of number needed to treat (NNT) and number needed to harm (NNH). METHODS Rates of response, remission, and all-cause discontinuation for zuranolone and 11 antidepressant comparators were obtained from the zuranolone phase 2 clinical study (N=89) and a published network meta-analysis, respectively. An indirect treatment comparison was conducted using the Bucher method to compare zuranolone to standard-of-care. RESULTS Zuranolone demonstrated greater benefit compared to placebo on Day 3 (NNT range for response=4-5, NNT for remission=10) and at Day 15 (NNT=3 for response and remission). Compared to SSRIs and SNRIs, zuranolone at Day 15 showed improved treatment response (NNT=4 [95% CI = 3; 16] and 5 [95% CI = 3; 25], respectively) and remission (NNT=4 [95% CI = 2; 13] and 4 [95% CI = 2; 18], respectively). This was accompanied by a reduction in all-cause discontinuation, with negative NNH values (-57 and -28), respectively. LIMITATIONS Variations in study design across the included trials may limit the generalizability of results. CONCLUSIONS With a small positive NNT as early as Day 3 indicating robust benefit and a negative NNH indicating reduced harm, this analysis based on a phase 2 study suggests that patients with MDD may benefit from the benefit-to-risk profile of zuranolone.
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163
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Youssef NA, Phung P, Patel RS. Characteristics of patients who received deep brain stimulation in obsessive-compulsive disorder versus major depressive disorder. J Psychiatr Res 2021; 136:384-387. [PMID: 33639331 DOI: 10.1016/j.jpsychires.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is cleared for treatment of obsessive-compulsive disorder (OCD) but is an investigational treatment for major depressive disorder (MDD). The aim of this study is to compare the characteristics of patients who received DBS as part of standard care for OCD versus those who received it a part of a research protocol for MDD. METHODS The inpatient sample (N = 110) was drawn from the 2012-2014 Nationwide Inpatient Sample (NIS), and included adults with a primary discharge diagnosis of MDD (N = 50) or OCD (N = 60) and primary procedure of DBS. The study compared various patient demographics, clinical, hospital and insurance variables between the 2 groups. RESULTS DBS recipients with OCD were younger compared to those with MDD. DBS recipients with MDD tended to be from high-income families compared to those with OCD. DBS patients with MDD were in the South region, while DBS patients with OCD were in the Midwest and South regions of the United States (US). The study did not detect a significant difference in the length of stay and total charges among DBS recipients with OCD versus MDD. CONCLUSIONS DBS patients with MDD are typically older with more financial resources compared to those with OCD. DBS is federally cleared for OCD, but not for MDD, demonstrating the need for further investigation to establish DBS as a federally cleared treatment for difficult to treat MDD if well-powered randomized trials further support its use.
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Affiliation(s)
- Nagy A Youssef
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, 997 St. Sebastian Way, Augusta, GA, 30912, USA.
| | - Phung Phung
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, 997 St. Sebastian Way, Augusta, GA, 30912, USA.
| | - Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, 900 E Main St, Norman, OK, 73071, USA; Department of Psychiatry and Behavioral Science, Oklahoma State University, 1111 W 17th St, Tulsa, OK, 74107, USA.
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164
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Lifestyle medicine for depression: A meta-analysis of randomized controlled trials. J Affect Disord 2021; 284:203-216. [PMID: 33609955 DOI: 10.1016/j.jad.2021.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined. METHODS We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons. RESULTS Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected. LIMITATIONS Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured. CONCLUSION Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.
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165
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Ramano EM, de Beer M, Roos JL. The perceptions of adult psychiatric inpatients with major depressive disorder towards occupational therapy activity-based groups. S Afr J Psychiatr 2021; 27:1612. [PMID: 33824758 PMCID: PMC8008034 DOI: 10.4102/sajpsychiatry.v27i0.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/16/2020] [Indexed: 11/05/2022] Open
Abstract
Background Occupational therapists have been using group therapy as their preferred treatment modality in mental healthcare since the origin of the profession. In private mental healthcare units, major depressive disorder (MDD) is the most common psychiatric disease. Occupational therapists use individual and group therapy to treat adult inpatients with MDD. Little is known about the perceptions and experiences of adult inpatients with MDD regarding occupational therapy activity-based groups. Aim To describe the perceptions and experiences of adult psychiatric inpatients with MDD towards occupational therapy activity-based groups. This article reports on the perceptions of adult psychiatric inpatients with MDD, which formed part of a larger study. Setting The study took place at two private general hospitals in Gauteng province, South Africa, each with a psychiatric ward. Methods The researcher used a qualitative explorative descriptive design. Accessible participants were selected using convenience sampling. Only consenting participants took part in the study. Data were collected during focus group discussions. Data were thematically analysed. Results Participants’ perceptions could be placed into one of four themes: (1) experience improved mood, (2) learned coping skills, (3) regained self-esteem and (4) becoming part of the solution to face life challenges. Conclusion Activities that are unique to occupational therapy profession can benefit inpatients with MDD. This supports the profession’s historical beliefs, assumptions and foundations regarding therapeutic use of activities. According to these inpatients, group activities improved their overall mental health.
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Affiliation(s)
- Enos M Ramano
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Marianne de Beer
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Johannes L Roos
- Department of Psychiatry, Faculty Health Sciences, University of Pretoria, Pretoria, South Africa
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166
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Du Y, Wei J, Yang X, Dou Y, Zhao L, Qi X, Yu X, Guo W, Wang Q, Deng W, Li M, Lin D, Li T, Ma X. Plasma metabolites were associated with spatial working memory in major depressive disorder. Medicine (Baltimore) 2021; 100:e24581. [PMID: 33663067 PMCID: PMC7909221 DOI: 10.1097/md.0000000000024581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
Major depressive disorder (MDD) is a common disease with both affective and cognitive disorders. Alterations in metabolic systems of MDD patients have been reported, but the underlying mechanisms still remains unclear. We sought to identify abnormal metabolites in MDD by metabolomics and to explore the association between differential metabolites and neurocognitive dysfunction.Plasma samples from 53 MDD patients and 83 sex-, gender-, BMI-matched healthy controls (HCs) were collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) system was then used to detect metabolites in those samples. Two different algorithms were applied to identify differential metabolites in 2 groups. Of the 136 participants, 35 MDD patients and 48 HCs had completed spatial working memory test. Spearman rank correlation coefficient was applied to explore the relationship between differential metabolites and working memory in these 2 groups.The top 5 metabolites which were found in sparse partial least squares-discriminant analysis (sPLS-DA) model and random forest (RF) model were the same, and significant difference was found in 3 metabolites between MDD and HCs, namely, gamma-glutamyl leucine, leucine-enkephalin, and valeric acid. In addition, MDD patients had higher scores in spatial working memory (SWM) between errors and total errors than HCs. Valeric acid was positively correlated with working memory in MDD group.Gamma-glutamyl leucine, leucine-enkephalin, and valeric acid were preliminarily proven to be decreased in MDD patients. In addition, MDD patients performed worse in working memory than HCs. Dysfunction in working memory of MDD individuals was associated with valeric acid.
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Affiliation(s)
- Yue Du
- Psychiatric Laboratory and Mental Health Center
| | - Jinxue Wei
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Xiao Yang
- Psychiatric Laboratory and Mental Health Center
| | - Yikai Dou
- Psychiatric Laboratory and Mental Health Center
| | - Liansheng Zhao
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Xueyu Qi
- Psychiatric Laboratory and Mental Health Center
| | - Xueli Yu
- Psychiatric Laboratory and Mental Health Center
| | - Wanjun Guo
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Qiang Wang
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Wei Deng
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Minli Li
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Dongtao Lin
- College of Foreign Languages and Cultures, Sichuan University, PR China
| | - Tao Li
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu
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167
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Gloger S, Martínez P, Behn A, Chacón MV, Cottin M, Diez de Medina D, Vöhringer PA. Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients. Eur J Psychotraumatol 2021; 12:1874600. [PMID: 34025917 PMCID: PMC8118528 DOI: 10.1080/20008198.2021.1874600] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.
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Affiliation(s)
- Sergio Gloger
- Psicomedica, Clinical & Research Group, Santiago, Chile.,Departamento de Psiquiatría y Salud Mental Campus Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Pablo Martínez
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile.,CITIAPS, Universidad de Santiago de Chile, Santiago, Chile
| | - Alex Behn
- ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Victoria Chacón
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Marianne Cottin
- ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Escuela de Psicología, Universidad Finis Terrae, Santiago, Chile
| | | | - Paul A Vöhringer
- Psicomedica, Clinical & Research Group, Santiago, Chile.,ANID, Millennium Science Initiative Program, Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.,Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
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168
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Ballard ED, Fields J, Farmer CA, Zarate CA. Clinical trials for rapid changes in suicidal ideation: Lessons from ketamine. Suicide Life Threat Behav 2021; 51:27-35. [PMID: 33624880 PMCID: PMC8201419 DOI: 10.1111/sltb.12663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Rapid-acting treatments for suicidal thoughts are critically needed. Consequently, there is a burgeoning literature exploring psychotherapeutic, pharmacologic, or device-based brief interventions for suicidal thoughts characterized by a rapid onset of action. Not only do these innovative treatments have potentially important clinical benefits to patient populations, they also highlight a number of methodological considerations for suicide research. First, while most clinical trials related to suicide risk focus on suicide attempts, new clinical trials that use suicidal thoughts as the primary outcome require a number of slight modifications to their clinical trial design. Second, the rapid onset of these new interventions permits an experimental therapeutics approach to suicide research, in which psychological and neurobiological markers are embedded into clinical trials to better understand the underlying pathophysiology of suicidal thoughts. The following review discusses these methodological innovations in light of recent research using the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine, which has been associated with rapid effects on suicidal thoughts. We hope that "lessons learned" from the ketamine literature will provide a blueprint for all researchers evaluating rapid-acting treatments for suicidal thoughts, whether pharmacologic or psychotherapeutic.
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Affiliation(s)
- Elizabeth D Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Jessica Fields
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Cristan A Farmer
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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169
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Fabbri C, Kasper S, Zohar J, Souery D, Montgomery S, Albani D, Forloni G, Ferentinos P, Rujescu D, Mendlewicz J, Serretti A, Lewis CM. Cost-effectiveness of genetic and clinical predictors for choosing combined psychotherapy and pharmacotherapy in major depression. J Affect Disord 2021; 279:722-729. [PMID: 33217644 DOI: 10.1016/j.jad.2020.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/09/2020] [Accepted: 10/25/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Predictors of treatment outcome in major depressive disorder (MDD) could contribute to evidence-based therapeutic choices. Combined pharmacotherapy and psychotherapy show increased efficacy but higher cost compared with antidepressant pharmacotherapy; baseline predictors of pharmacotherapy resistance could be used to identify patients more likely to benefit from combined treatment. METHODS We performed a proof-of-principle study of the cost-effectiveness of using previously identified pharmacogenetic and clinical risk factors (PGx-CL-R) of antidepressant resistance or clinical risk factors alone (CL-R) to guide the prescription of combined pharmacotherapy and psychotherapy vs pharmacotherapy. The cost-effectiveness of these two strategies was compared with standard care (ST, pharmacotherapy to all subjects) using a three-year Markov model. Model parameters were literature-based estimates of response to pharmacotherapy and combined treatment, costs (UK National Health System) and benefits (quality-adjusted life years [QALYs], one QALY=one year lived in perfect health). RESULTS CL-R was more cost-effective than PGx-CL-R: the cost of one-QALY improvement was £2341 for CL-R and £3937 for PGx-CL-R compared to ST. PGx-CL-R had similar or better cost-effectiveness compared to CL-R when 1) the cost of genotyping was £100 per subject or less or 2) the PGx-CL-R test had sensitivity ≥ 0.90 and specificity ≥ 0.85. The cost of one-QALY improvement for CL-R was £3664 and of £4110 in two independent samples. LIMITATIONS lack of validation in large samples from the general population. CONCLUSIONS Using clinical risk factors to predict pharmacotherapy resistance and guide the prescription of pharmacotherapy combined with psychotherapy could be a cost-effective strategy.
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Affiliation(s)
- Chiara Fabbri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Austria
| | - Joseph Zohar
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Daniel Souery
- Laboratoire de Psychologie Medicale, Universitè Libre de Bruxelles and Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels
| | | | - Diego Albani
- Laboratory of Biology of Neurodegenerative Disorders, Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianluigi Forloni
- Laboratory of Biology of Neurodegenerative Disorders, Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Dan Rujescu
- University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg, Germany
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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170
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Drug repositioning for treatment-resistant depression: Hypotheses from a pharmacogenomic study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110050. [PMID: 32738352 DOI: 10.1016/j.pnpbp.2020.110050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Abstract
About 20-30% of patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD) and finding new effective treatments for TRD has been a challenge. This study aimed to identify new possible pharmacological options for TRD. Genes in pathways included in predictive models of TRD in a previous whole exome sequence study were compared with those coding for targets of drugs in any phase of development, nutraceuticals, proteins and peptides from Drug repurposing Hub, Drug-Gene Interaction database and DrugBank database. We tested if known gene targets were enriched in TRD-associated genes by a hypergeometric test. Compounds enriched in TRD-associated genes after false-discovery rate (FDR) correction were annotated and compared with those showing enrichment in genes associated with MDD in the last Psychiatric Genomics Consortium genome-wide association study. Among a total of 15,475 compounds, 542 were enriched in TRD-associated genes (FDR p < .05). Significant results included drugs which are currently used in TRD (e.g. lithium and ketamine), confirming the rationale of this approach. Interesting molecules included modulators of inflammation, renin-angiotensin system, proliferator-activated receptor agonists, glycogen synthase kinase 3 beta inhibitors and the rho associated kinase inhibitor fasudil. Nutraceuticals, mostly antioxidant polyphenols, were also identified. Drugs showing enrichment for TRD-associated genes had a higher probability of enrichment for MDD-associated genes compared to those having no TRD-genes enrichment (p = 6.21e-55). This study suggested new potential treatments for TRD using a in silico approach. These analyses are exploratory only but can contribute to the identification of drugs to study in future clinical trials.
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171
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Maffioletti E, Bocchio-Chiavetto L, Perusi G, Carvalho Silva R, Sacco C, Bazzanella R, Zampieri E, Bortolomasi M, Gennarelli M, Minelli A. Inflammation-related microRNAs are involved in stressful life events exposure and in trauma-focused psychotherapy in treatment-resistant depressed patients. Eur J Psychotraumatol 2021; 12:1987655. [PMID: 35070159 PMCID: PMC8772504 DOI: 10.1080/20008198.2021.1987655] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND About 30% of major depressive disorder (MDD) patients are classified as resistant to treatment (treatment-resistant depression, TRD). Among the factors associated with unfavourable treatment outcomes, stressful life events play a relevant role, and trauma-focused psychotherapy has been successfully proposed for the treatment of patients with a history of such events. Stressful experiences are related to enhanced inflammation and, recently, microRNAs (miRNAs) have emerged as potential mediators of the association between these experiences and psychiatric disorders. To date, no study has explored the effects of stressful life events on miRNAs in MDD patients. OBJECTIVE The objective of the present study was to assess possible miRNA blood expression alterations in TRD patients induced by the exposure to stressful life events and to investigate the effects of trauma-focused psychotherapy on the expression profiles of the same miRNAs, as well as their possible predictivity in relation to therapy outcome. METHOD The basal levels (T0) of seven candidate miRNAs (miR-15a/miR-29a/miR-125b/miR-126/miR-146a/miR-195/let-7f) were measured in the whole blood of 41 TRD patients. A subgroup of patients (n = 21) underwent trauma-focused psychotherapy; for all of them, miRNA levels were also longitudinally assessed (T4: after 4 weeks of treatment; T8: end of treatment; T12: follow-up visit), contextually to clinical evaluations. RESULTS miR-146a levels negatively correlated with recent stressful life event scores (p = .001), whereas the levels of miR-15a, miR-29a, miR-126, miR-195, and let-7f changed during the psychotherapy (best p = 1.98*10-9). miR-29a was also identified as a response predictor, with lower baseline levels predicting non-response (p = .019) or worse improvement in mood symptoms (p = .032). CONCLUSIONS The study results could contribute to clarify the underlying molecular mechanisms and to identify novel biomarkers of stressful experiences and response to targeted treatments.
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Affiliation(s)
- Elisabetta Maffioletti
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Luisella Bocchio-Chiavetto
- Genetics Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Psychiatric Unit, IRCCS Istituto Centro S. Giovanni di Dio, Brescia, Italy.,Department of Theoretical and Applied Sciences, eCampus University, Como, Novedrate, Italy
| | - Giulia Perusi
- Psychiatric Hospital "Villa Santa Chiara", Verona, Italy
| | - Rosana Carvalho Silva
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Chiara Sacco
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Elisa Zampieri
- Psychiatric Hospital "Villa Santa Chiara", Verona, Italy
| | | | - Massimo Gennarelli
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Psychiatric Unit, IRCCS Istituto Centro S. Giovanni di Dio, Brescia, Italy
| | - Alessandra Minelli
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetics Unit, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Psychiatric Unit, IRCCS Istituto Centro S. Giovanni di Dio, Brescia, Italy
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172
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Richardson L, Brahmbhatt A. Depression in Primary Care. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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173
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Du Y, Wei J, Zhang Z, Yang X, Wang M, Wang Y, Qi X, Zhao L, Tian Y, Guo W, Wang Q, Deng W, Li M, Lin D, Li T, Ma X. Plasma Metabolomics Profiling of Metabolic Pathways Affected by Major Depressive Disorder. Front Psychiatry 2021; 12:644555. [PMID: 34646171 PMCID: PMC8502978 DOI: 10.3389/fpsyt.2021.644555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Major depressive disorder (MDD) is a common disease which is complicated by metabolic disorder. Although MDD has been studied relatively intensively, its metabolism is yet to be elucidated. Methods: To profile the global pathophysiological processes of MDD patients, we used metabolomics to identify differential metabolites and applied a new database Metabolite set enrichment analysis (MSEA) to discover dysfunctions of metabolic pathways of this disease. Hydrophilic metabolomics were applied to identify metabolites by profiling the plasma from 55 MDD patients and 100 sex-, gender-, BMI-matched healthy controls. The metabolites were then analyzed in MSEA in an attempt to discover different metabolic pathways. To investigate dysregulated pathways, we further divided MDD patients into two cohorts: (1) MDD patients with anxiety symptoms and (2) MDD patients without anxiety symptoms. Results: Metabolites which were hit in those pathways correlated with depressive and anxiety symptoms. Altogether, 17 metabolic pathways were enriched in MDD patients, and 23 metabolites were hit in those pathways. Three metabolic pathways were enriched in MDD patients without anxiety, including glycine and serine metabolism, arginine and proline metabolism, and phenylalanine and tyrosine metabolism. In addition, L-glutamic acid was positively correlated with the severity of depression and retardation if hit in MDD patients without anxiety symptoms. Conclusions: Different kinds of metabolic pathophysiological processes were found in MDD patients. Disorder of glycine and serine metabolism was observed in both MDD patients with anxiety and those without.
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Affiliation(s)
- Yue Du
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jinxue Wei
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zijian Zhang
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao Yang
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Min Wang
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Wang
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiongwei Qi
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Liansheng Zhao
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Tian
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjun Guo
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wang
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Deng
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Minli Li
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Dongtao Lin
- College of Foreign Languages and Cultures, Sichuan University, Chengdu, China
| | - Tao Li
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
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174
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Liang S, Zhang J, Zhao Q, Wilson A, Huang J, Liu Y, Shi X, Sha S, Wang Y, Zhang L. Incidence Trends and Risk Prediction Nomogram for Suicidal Attempts in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:644038. [PMID: 34248696 PMCID: PMC8261285 DOI: 10.3389/fpsyt.2021.644038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Major depressive disorder (MDD) is often associated with suicidal attempt (SA). Therefore, predicting the risk factors of SA would improve clinical interventions, research, and treatment for MDD patients. This study aimed to create a nomogram model which predicted correlates of SA in patients with MDD within the Chinese population. Method: A cross-sectional survey among 474 patients was analyzed. All subjects met the diagnostic criteria of MDD according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Multi-factor logistic regression analysis was used to explore demographic information and clinical characteristics associated with SA. A nomogram was further used to predict the risk of SA. Bootstrap re-sampling was used to internally validate the final model. Integrated Discrimination Improvement (IDI) and Akaike Information Criteria (AIC) were used to evaluate the capability of discrimination and calibration, respectively. Decision Curve Analysis (DCA) and the Receiver Operating Characteristic (ROC) curve was also used to evaluate the accuracy of the prediction model. Result: Multivariable logistic regression analysis showed that being married (OR = 0.473, 95% CI: 0.240 and 0.930) and a higher level of education (OR = 0.603, 95% CI: 0.464 and 0.784) decreased the risk of the SA. The higher number of episodes of depression (OR = 1.854, 95% CI: 1.040 and 3.303) increased the risk of SA in the model. The C-index of the nomogram was 0.715, with the internal (bootstrap) validation sets was 0.703. The Hosmer-Lemeshow test yielded a P-value of 0.33, suggesting a good fit of the prediction nomogram in the validation set. Conclusion: Our findings indicate that the demographic information and clinical characteristics of SA can be used in a nomogram to predict the risk of SA in Chinese MDD patients.
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Affiliation(s)
- Sixiang Liang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jinhe Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Amanda Wilson
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Juan Huang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuan Liu
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaoning Shi
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Wang
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
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175
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Leis A, Ronzano F, Mayer MA, Furlong LI, Sanz F. Evaluating Behavioral and Linguistic Changes During Drug Treatment for Depression Using Tweets in Spanish: Pairwise Comparison Study. J Med Internet Res 2020; 22:e20920. [PMID: 33337338 PMCID: PMC7775819 DOI: 10.2196/20920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Depressive disorders are the most common mental illnesses, and they constitute the leading cause of disability worldwide. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed drugs for the treatment of depressive disorders. Some people share information about their experiences with antidepressants on social media platforms such as Twitter. Analysis of the messages posted by Twitter users under SSRI treatment can yield useful information on how these antidepressants affect users’ behavior. Objective This study aims to compare the behavioral and linguistic characteristics of the tweets posted while users were likely to be under SSRI treatment, in comparison to the tweets posted by the same users when they were less likely to be taking this medication. Methods In the first step, the timelines of Twitter users mentioning SSRI antidepressants in their tweets were selected using a list of 128 generic and brand names of SSRIs. In the second step, two datasets of tweets were created, the in-treatment dataset (made up of the tweets posted throughout the 30 days after mentioning an SSRI) and the unknown-treatment dataset (made up of tweets posted more than 90 days before or more than 90 days after any tweet mentioning an SSRI). For each user, the changes in behavioral and linguistic features between the tweets classified in these two datasets were analyzed. 186 users and their timelines with 668,842 tweets were finally included in the study. Results The number of tweets generated per day by the users when they were in treatment was higher than it was when they were in the unknown-treatment period (P=.001). When the users were in treatment, the mean percentage of tweets posted during the daytime (from 8 AM to midnight) increased in comparison to the unknown-treatment period (P=.002). The number of characters and words per tweet was higher when the users were in treatment (P=.03 and P=.02, respectively). Regarding linguistic features, the percentage of pronouns that were first-person singular was higher when users were in treatment (P=.008). Conclusions Behavioral and linguistic changes have been detected when users with depression are taking antidepressant medication. These features can provide interesting insights for monitoring the evolution of this disease, as well as offering additional information related to treatment adherence. This information may be especially useful in patients who are receiving long-term treatments such as people suffering from depression.
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Affiliation(s)
- Angela Leis
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Francesco Ronzano
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Laura I Furlong
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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176
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Dold M, Bartova L, Fugger G, Mitschek MMM, Kautzky A, Frey R, Montgomery S, Zohar J, Mendlewicz J, Souery D, Fabbri C, Serretti A, Kasper S. Add-on benzodiazepine treatment in patients with major depressive disorder - results from a European cross-sectional multicenter study. Eur Neuropsychopharmacol 2020; 41:70-80. [PMID: 33046351 DOI: 10.1016/j.euroneuro.2020.09.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
Since many patients with major depressive disorder (MDD) do not satisfactorily respond to initial antidepressant monotherapy, add-on treatment strategies with other psychiatric compounds are often established. The present European multicenter cross-sectional study comprising 1410 MDD in- and outpatients investigated the prescription pattern of benzodiazepines as add-on treatment in the psychopharmacotherapy of MDD. Analyses of variance, chi-squared tests, and logistic regression analyses were conducted to examine differences in socio-demographic, clinical, and treatment characteristics between benzodiazepine users and non-users. The prescription rate for adjunctive benzodiazepine treatment amounted to 31.35%. The most often administered benzodiazepines were lorazepam (11.13%), clonazepam (6.74%), and alprazolam (6.60%). Benzodiazepine users exhibited more severe depressive symptoms expressed by a higher mean Montgomery and Åsberg Depression Rating Scale total score at study entry (26.92 ± 11.07 vs 23.55 ± 11.23, p<.0001) and at the beginning of the current major depressive episode (35.74 ± 8.08 vs 33.31 ± 7.40, p<.0001). Furthermore, they were characterized by a higher proportion of patients receiving additional augmentation/combination medications with antidepressants (40.95% vs 24.28%, p<.0001), antipsychotics (41.63% vs 18.39%, p<.0001), and low-potency antipsychotics (10.18% vs 4.75%, p<.0001). Moreover, benzodiazepine prescription was associated with older age, unemployment, inpatient treatment, suicide risk, psychotic and melancholic features, comorbid panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder. Taken together, our findings indicate that benzodiazepine augmentation in MDD is first of all established in severe/difficult-to-treat conditions and serves as predictor for the use of additional augmentation/combination treatment strategies.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria.
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177
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Nobis A, Zalewski D, Waszkiewicz N. Peripheral Markers of Depression. J Clin Med 2020; 9:E3793. [PMID: 33255237 PMCID: PMC7760788 DOI: 10.3390/jcm9123793] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Major Depressive Disorder (MDD) is a leading cause of disability worldwide, creating a high medical and socioeconomic burden. There is a growing interest in the biological underpinnings of depression, which are reflected by altered levels of biological markers. Among others, enhanced inflammation has been reported in MDD, as reflected by increased concentrations of inflammatory markers-C-reactive protein, interleukin-6, tumor necrosis factor-α and soluble interleukin-2 receptor. Oxidative and nitrosative stress also plays a role in the pathophysiology of MDD. Notably, increased levels of lipid peroxidation markers are characteristic of MDD. Dysregulation of the stress axis, along with increased cortisol levels, have also been reported in MDD. Alterations in growth factors, with a significant decrease in brain-derived neurotrophic factor and an increase in fibroblast growth factor-2 and insulin-like growth factor-1 concentrations have also been found in MDD. Finally, kynurenine metabolites, increased glutamate and decreased total cholesterol also hold promise as reliable biomarkers for MDD. Research in the field of MDD biomarkers is hindered by insufficient understanding of MDD etiopathogenesis, substantial heterogeneity of the disorder, common co-morbidities and low specificity of biomarkers. The construction of biomarker panels and their evaluation with use of new technologies may have the potential to overcome the above mentioned obstacles.
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Affiliation(s)
- Aleksander Nobis
- Department of Psychiatry, Medical University of Bialystok, pl. Brodowicza 1, 16-070 Choroszcz, Poland; (D.Z.); (N.W.)
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178
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Akinbode TD, Pedersen C, Lara-Cinisomo S. The Price of Pre-adolescent Abuse: Effects of Sexual Abuse on Perinatal Depression and Anxiety. Matern Child Health J 2020; 25:1083-1093. [PMID: 33206305 DOI: 10.1007/s10995-020-03088-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Childhood abuse is a major public health concern and a risk factor for subsequent poor maternal mental health. This study of 176 racially diverse women explored the associations between the histories of childhood sexual abuse and depression and anxiety during pregnancy, at six weeks postpartum, and 12 weeks postpartum. METHODS Data on depressive and anxiety symptoms were gathered during pregnancy, at six weeks postpartum, and 12 weeks postpartum. Sociodemographic data were collected during pregnancy, while data on childhood sexual abuse were gathered during the 12-week postpartum period. Bivariate analyses and repeated mixed-effects linear regression with bootstrapping were used to assess the association between childhood sexual abuse and perinatal depressive and anxiety symptoms. RESULTS Childhood sexual abuse was significantly associated with depressive symptoms (β = 2.52, 95% CI 1.72, 3.32, p < .001) and anxiety symptoms (β = 4.44, 95% CI 3.70, 5.81, p < .001) over time, while controlling for demographic characteristics and lifetime major depression and anxiety. Depressive and anxiety symptoms decreased over the perinatal period and were highest during pregnancy. Black women were more likely to report higher depressive symptoms (β = 1.35, 95% CI 0.51, 2.19, p = .002) and anxiety symptoms (β = 3.29 95% CI 1.72, 4.87, p < .001) over time compared to White women. DISCUSSION The results highlight the importance of assessing the long-term effects of childhood sexual abuse on perinatal depressive and anxiety symptoms to help inform the development of interventions for women, particularly Black women.
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Affiliation(s)
- Tanitoluwa Demilade Akinbode
- College of Agricultural, Consumer & Environmental Sciences, Department of Human Development & Family Studies, University of Illinois at Urbana-Champaign, 222 Bevier Hall, 905 S. Goodwin Avenue, Urbana, 61801, IL, USA.
| | - Cort Pedersen
- Department of Psychiatry, The University of North Carolina at Chapel Hill, CB #7160, Chapel Hill, 27599, NC, USA
| | - Sandraluz Lara-Cinisomo
- College of Applied Health Sciences, Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 1206 S. Fourth St, Champaign, 61820, IL, USA
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179
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Intravenous vortioxetine to accelerate onset of effect in major depressive disorder: a 7-day randomized, double-blind, placebo-controlled exploratory study. Int Clin Psychopharmacol 2020; 35:305-312. [PMID: 32784346 PMCID: PMC7531504 DOI: 10.1097/yic.0000000000000326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This 7-day randomized, double-blind, placebo-controlled fixed-dose study (NCT03766867) explored the potential for accelerating the onset of antidepressant efficacy of single-dose intravenous (IV) vortioxetine at oral vortioxetine treatment initiation. Patients (ages 18-65 years) hospitalized per standard-of-care with major depressive disorder, who were currently treated with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor for a major depressive episode [Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥ 30], received one dose of single-blind IV placebo (1-day placebo lead-in period) before being randomly switched to either single-dose IV vortioxetine 25 mg plus daily oral vortioxetine 10 mg (n = 39), or IV placebo plus daily oral placebo (n = 41). In the placebo lead-in period, patients improved slightly by 0.6 MADRS-6 point; however, at day 1 after randomization, both treatment groups had improved by approximately 3 MADRS-6 points (mean difference = -0.8; P = 0.263), the study thus not meeting its primary endpoint. Similar results were seen for other outcomes except a numerically larger improvement in anxiety symptoms with vortioxetine vs placebo. Pharmacokinetic data confirmed that IV vortioxetine facilitated reaching steady-state plasma concentration within 24 h. IV plus oral vortioxetine was well tolerated, with low levels of nausea as the most common adverse event.
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180
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Cosci F, Mansueto G, Fava GA. Relapse prevention in recurrent major depressive disorder. A comparison of different treatment options based on clinical experience and a critical review of the literature. Int J Psychiatry Clin Pract 2020; 24:341-348. [PMID: 32716222 DOI: 10.1080/13651501.2020.1779308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reducing the risk of relapses is a critical component of major depressive disorders treatment. Guidelines suggest maintenance with antidepressant drugs in recurrent depression, but this solution has recently been questioned. OBJECTIVE The aim of this article is to provide a critical review of the literature of the main treatment options currently available to prevent relapse and recurrence in depression. METHODS We compared long-term antidepressant therapy (i.e., indefinite maintenance of antidepressant), intermittent antidepressant therapy (i.e., use of antidepressants mainly limited to the acute phases), use of psychotherapy in the sequential model (i.e., pharmacotherapy in the acute phase and psychotherapy in the residual phase). RESULTS We argue that the same solution may not apply to all patients and question the feasibility of a single course of treatment in the setting of complex disorders that are encountered in practice. The clinician should weigh advantages and disadvantages in the individual case. CONCLUSIONS The sequential model appears to be particularly indicated in recurrent depression. KEY POINTS Relapse is a major challenge of depressive disorders treatment Treatment options currently available include long-term antidepressants, intermittent antidepressants, addition of psychotherapy to pharmacotherapy in the sequential model Maintenance with antidepressants in recurrent depression has recently been questioned The sequential model appears to be particularly indicated in recurrent depression.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Andrea Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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181
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Treating major depression and comorbid disorders with transcranial magnetic stimulation. J Affect Disord 2020; 276:453-460. [PMID: 32871677 PMCID: PMC7505211 DOI: 10.1016/j.jad.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a global disorder that negatively affects mood and quality of life. Antidepressant medication and psychotherapy are the most commonly prescribed treatments, but prior research has called their clinical efficacy into question. These treatments may be less effective when the patient has a diagnosed comorbid disorder. METHOD A systematic review of the literature was conducted to investigate whether an alternative method of treatment, Transcranial Magnetic Stimulation (TMS), is effective for MDD with a diagnosed comorbidity. 110 articles were identified, of which 8 were included in the current review. RESULTS Response and remission rates vary. A range of 39.5-70% of participants experienced an antidepressant response to treatment, and 16.6-76.9% of patients achieved remission from MDD. A range of 48.6-84.6% of participants responded to treatment of their comorbid disorder, and 50-84.6% achieved remission of comorbid symptoms. LIMITATIONS Limitations of the current review include small sample sizes, limited statistical power, homogenous samples, and a lack of sham or placebo-controlled studies. CONCLUSION Preliminary results support that TMS is effective at treating symptoms of MDD and a comorbid disorder. Additional studies are needed to confirm these results.
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182
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Pirard P, Baubet T, Motreff Y, Rabet G, Marillier M, Vandentorren S, Vuillermoz C, Stene LE, Messiah A. Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris. BMC Health Serv Res 2020; 20:959. [PMID: 33076901 PMCID: PMC7574168 DOI: 10.1186/s12913-020-05785-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD). Methods Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use. Results Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps. Conclusion Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.
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Affiliation(s)
- Philippe Pirard
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France. .,Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Thierry Baubet
- CESP, Inserm, Université Sorbonne Paris Nord, Villetaneuse, France.,APHP, Hôpital Avicenne, Bobigny, France.,Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
| | - Yvon Motreff
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France.,Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Gabrielle Rabet
- Support, Data Treatment and Analysis Division, Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Maude Marillier
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Stéphanie Vandentorren
- Scientific and International Division, Santé Publique France (The French Public Health Agency), Saint-Maurice, France.,INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ Bordeaux, F-33000, Bordeaux, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Antoine Messiah
- Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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183
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Abdallah MS, Mosalam EM, Zidan AAA, Elattar KS, Zaki SA, Ramadan AN, Ebeid AM. The Antidiabetic Metformin as an Adjunct to Antidepressants in Patients with Major Depressive Disorder: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial. Neurotherapeutics 2020; 17:1897-1906. [PMID: 32500486 PMCID: PMC7851215 DOI: 10.1007/s13311-020-00878-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Metformin (MET) has been reported to have antidepressant effects in animal models and in diabetic patients with depression, owing to its anti-inflammatory, antioxidant, and neuroprotective activity. Accordingly, we proposed that MET would show antidepressant effects in patients with major depressive disorder (MDD) without other comorbidities. In this double-blind placebo-controlled study, 80 adult outpatients with MDD (DSM-IV criteria) and a Hamilton Depression Rating Scale (HAM-D) score >18 were randomized to receive fluoxetine 20 mg once daily plus placebo (n = 40) or fluoxetine 20 mg once daily plus MET 1000 mg once daily for 12 weeks. Patients were assessed by HAM-D score (weeks 0, 4, 8, and 12). The serum levels of TNF-α, IL-1β, IL-6, IGF-1, MDA, CRP, BDNF, and serotonin were measured before and after therapy. Mixed-effects model repeated-measures analysis of covariance was used to compare the HAM-D scores and the biological markers between the two groups. After 4, 8 and 12 weeks, patients in the MET group showed a statistically significant decline in HAM-D score relative to the placebo group (least squares mean difference [LSMD] -2.347, p = 0.000, LSMD -3.369, p = 0.000, and LSMD -3.454, p = 0.000, respectively). Response and remission rates were significantly higher in the MET group (89% and 81%, respectively) than in the placebo group (59% and 46%, respectively). Moreover, the MET group was superior in conserving the measured biological markers compared with the placebo group. Our findings suggest MET as a promising, effective, and safe short-term adjunctive approach in nondiabetic MDD patients. Trial registration ID: NCT04088448.
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Affiliation(s)
- Mahmoud S Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, Menoufia, 32897, Egypt.
| | - Esraa M Mosalam
- Department of Biochemistry, Faculty of Pharmacy, Menoufia University, Menoufia, Egypt
| | - Abdel-Aziz A Zidan
- Zoology Department, Faculty of Science, Damanhour University, Damanhour & Center of Excellence in Cancer Research (CECR), Tanta University, Tanta, Egypt
| | - Khaled S Elattar
- Consultant of Psychiatry & Private Psychiatric Hospital Manager, 10th of Ramadan, Egypt
| | - Shimaa A Zaki
- Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ahmed N Ramadan
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Abla M Ebeid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Delta University for Science and Technology, Gamasaa, Egypt
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184
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Döbrössy MD, Ramanathan C, Ashouri Vajari D, Tong Y, Schlaepfer T, Coenen VA. Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle. Eur J Neurosci 2020; 53:89-113. [PMID: 32931064 DOI: 10.1111/ejn.14975] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 07/24/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022]
Abstract
Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment-resistant depressed patients-one of several targets under investigation-has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.
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Affiliation(s)
- Máté D Döbrössy
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany
| | - Chockalingam Ramanathan
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Danesh Ashouri Vajari
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Yixin Tong
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Thomas Schlaepfer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Interventional Biological Psychiatry, University Hospital Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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185
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Akhtar P, Ma L, Waqas A, Naveed S, Li Y, Rahman A, Wang Y. Prevalence of depression among university students in low and middle income countries (LMICs): a systematic review and meta-analysis. J Affect Disord 2020; 274:911-919. [PMID: 32664032 DOI: 10.1016/j.jad.2020.03.183] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Though university years are peak time for the onset of many mental health problems including depression, knowledge on the prevalence of depressive symptoms among university students in low and middle-income countries (LMICs) is limited. This study examined the prevalence of depressive symptoms among university students in LMICs. METHODS We systematically searched PubMed, Web of Science, and WHO Global Health Library for studies published between January 1, 2009 and December 31, 2018. Cross-sectional and longitudinal studies conducted in LMICs (as defined by World Bank), having a sample size≥500 and published in English were identified. Data on study characteristics and prevalence of depressive symptoms was extracted by two investigators. Estimate of prevalence was pooled in meta-analysis using random-effects meta-analysis. Sub-group differences were estimated using mixed-effects meta-analysis and meta-regression. RESULTS Depressive symptoms prevalence data were extracted from 37 studies involving 76,608 individuals in 20 countries. Studies on depression among university students in LMICs were limited, and most were based on non-representative and small study samples. The overall prevalence of depressive symptoms was 24.4% (95% CI, 19.2% -30.5%). Subgroup analysis revealed that the prevalence did not vary by study design, sampling technique, sample size, study major, educational level, economic regions, and screening instrument. LIMITATIONS Only English language studies were included. Included studies were diverse in design, screening tool, and sample size that introduced substantial heterogeneity. CONCLUSION Overall prevalence of depressive symptoms among university students in LMICs was 24.4%, however, finding should be interpreted with caution. Further research is needed to address the issue.
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Affiliation(s)
- Parveen Akhtar
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Lu Ma
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Ahmed Waqas
- Human Development Research Foundation, Pakistan
| | - Sadiq Naveed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Yixuan Li
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Atif Rahman
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA..
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186
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Manzoor S, Hoda N. A comprehensive review of monoamine oxidase inhibitors as Anti-Alzheimer's disease agents: A review. Eur J Med Chem 2020; 206:112787. [PMID: 32942081 DOI: 10.1016/j.ejmech.2020.112787] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
Monoamine oxidases (MAO-A and MAO-B) are mammalian flavoenzyme, which catalyze the oxidative deamination of several neurotransmitters like norepinephrine, dopamine, tyramine, serotonin, and some other amines. The oxidative deamination produces several harmful side products like ammonia, peroxides, and aldehydes during the biochemical reaction. The concentration of biochemical neurotransmitter alteration in the brain by MAO is directly related with several neurological disorders like Alzheimer's disease and Parkinson's disease (PD). Activated MAO also contributes to the amyloid beta (Aβ) aggregation by two successive cleft β-secretase and γ-secretase of amyloid precursor protein (APP). Additionally, activated MAO is also involved in aggregation of neurofibrillary tangles and cognitive destruction through the cholinergic neuronal damage and disorder of the cholinergic system. MAO inhibition has general anti-Alzheimer's disease effect as a consequence of oxidative stress reduction prompted by MAO enzymes. In this review, we outlined and addressed recent understanding on MAO enzymes such as their structure, physiological function, catalytic mechanism, and possible therapeutic goals in AD. In addition, it also highlights the current development and discovery of potential MAO inhibitors (MAOIs) from various chemical scaffolds.
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Affiliation(s)
- Shoaib Manzoor
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Nasimul Hoda
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia, New Delhi, 110025, India.
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187
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Al-Alawi M, Brietzke E, Carvalhal A, Soares CN. The potential anti-depressant properties of dexmedetomidine infusion: a review of mechanistic, preclinical, and clinical evidence. Rev Neurosci 2020; 31:649-658. [PMID: 32573483 DOI: 10.1515/revneuro-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022]
Abstract
Major depressive disorder (MDD) is a highly prevalent and disabling condition for which the currently available treatments are not fully effective. Existing unmet needs include rapid onset of action and optimal management of concurrent agitation. Dexmedetomidine (DEX) is a selective and potent α2-adrenergic receptor (α2-AR) agonist, with unique pharmacokinetic and pharmacodynamic properties. In this review, we discuss pre-clinical and clinical studies which focused on DEX in the context of its putative antidepressant effects for the management of MDD. Preliminary data support DEX as an antidepressant with fast onset of action, which would be especially helpful for patients experiencing treatment resistant depression, and agitation. We further explore the mechanistic and clinical implications of considering DEX as a putative antidepressant agent, and the next steps to explore the efficacy of low dose DEX infusion among patients with treatment resistant depression.
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Affiliation(s)
- Mohammed Al-Alawi
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Elisa Brietzke
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
| | - Adriana Carvalhal
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queens University School of Medicine, 752 King Street West, Postal Bag 603, Kingston, ONK7L 7X3, Canada
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188
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Harris MG, Kazdin AE, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Cardoso G, Cía A, Florescu S, Gureje O, Hu C, Karam EG, Karam G, Mneimneh Z, Navarro-Mateu F, Oladeji BD, O’Neill S, Scott K, Slade T, Torres Y, Vigo D, Wojtyniak B, Zarkov Z, Ziv Y, Kessler RC. Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder. JAMA Psychiatry 2020; 77:830-841. [PMID: 32432716 PMCID: PMC7240636 DOI: 10.1001/jamapsychiatry.2020.1107] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
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Affiliation(s)
- Meredith G. Harris
- The University of Queensland School of Public Health, Herston, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Ali Al-Hamzawi
- Al-Qadisiya University College of Medicine, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- IMIM–Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain,Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain,CIBER en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM 23), Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Alfredo Cía
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | | | - Siobhan O’Neill
- Ulster University School of Psychology, Londonderry, United Kingdom
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bogdan Wojtyniak
- National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Directorate of Mental Health and Prevention of Addictions, Sofia, Bulgaria
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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189
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Chou PH, Lu MK, Tsai CH, Hsieh WT, Lai HC, Shityakov S, Su KP. Antidepressant efficacy and immune effects of bilateral theta burst stimulation monotherapy in major depression: A randomized, double-blind, sham-controlled study. Brain Behav Immun 2020; 88:144-150. [PMID: 32592861 DOI: 10.1016/j.bbi.2020.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Inflammation theory has been consolidated by accumulating evidence, and many studies have suggested that the peripheral cytokine levels could be biomarkers for disease status and treatment outcome in major depressive disorder (MDD). Theta burst stimulation (TBS), a new form of repetitive transcranial magnetic stimulation (TMS) for MDD, has been demonstrated to improve depression via modulating dysfunctional neural network or hypothalamic–pituitary–adrenal axis hyperactivities in MDD. However, there is lack of exploratory studies investigating its effect on serum inflammatory cytokines. Here, we aimed to investigate the antidepressant efficacy of bilateral TBS monotherapy and its effects on the serum cytokine levels in MDD. We conducted a double-blind, randomized, sham-controlled trial, with 53 MDD patients who exhibited no responses to at least one adequate antidepressant treatment for the prevailing episode assigned randomly to one of two groups: bilateral TBS monotherapy (n = 27) or sham stimulation (n = 26). The TBS treatment period was 22 days. Blood samples from 31 study subjects were obtained for analyses. The bilateral TBS group exhibited significantly greater decreases in depression scores than the sham group at week 4 (56.5% vs. 33.1%; p < 0.001 [effect size (Cohen ’ s d) = 1.00]) and during the 20-week follow-up periods. Significantly more responders were also found at week 4 (70.3% vs. 23.1%, p = 0.001) and during the 20-week follow-up periods. However, we did not detect any significant effects of TBS on the cytokine panels or any correlations between improvement in depressive symptoms and changes in serum inflammatory markers. Our findings provided the first evidence that the antidepressant efficacy of bilateral TBS monotherapy might not work via immune-modulating mechanisms.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Taiwan Allied Clinics for Integrative TMS, Taipei, Taiwan
| | - Ming-Kuei Lu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Wan-Ting Hsieh
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Hui-Chen Lai
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Sergey Shityakov
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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190
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Kim S, Baek JH, Shim SH, Kwon YJ, Lee HY, Yoo JH, Kim JS. Mismatch negativity indices and functional outcomes in unipolar and bipolar depression. Sci Rep 2020; 10:12831. [PMID: 32732996 PMCID: PMC7393365 DOI: 10.1038/s41598-020-69776-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/17/2020] [Indexed: 01/12/2023] Open
Abstract
The aim of the study was to explore the association between functional outcomes and mismatch negativity (MMN) activity in participants with mood disorders. The study participants were 27 subjects with major depressive disorder (MDD), 29 subjects with bipolar disorder (BD), and 33 healthy controls who performed a passive auditory oddball paradigm while electroencephalography (EEG) was recorded. Peak amplitudes and source activity of the MMN were compared across groups. Mood and anxiety symptoms were evaluated. The functional levels were the lowest in the BD group, followed by the MDD and healthy control groups. The subjects with BD had significantly lower MMN amplitudes at the frontal and frontocentral electrodes than the healthy controls. The source activity of the MMN from the left anterior cingulate cortex, inferior frontal gyrus, and middle frontal gyrus was significantly increased in the BD group compared to the MDD group. Significant correlations were detected between the functional outcomes and MMN amplitudes at frontal and frontocentral sites. The functional outcome was significantly correlated with left frontal regions. In conclusion, MMN activity appears to be a promising candidate as an evaluation tool for functional outcomes in mood disorders.
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Affiliation(s)
- Sungkean Kim
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Seoul, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Young Joon Kwon
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Hwa Young Lee
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Jae Hyun Yoo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Sun Kim
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea.
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191
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Borentain S, Nash AI, Dayal R, DiBernardo A. Patient-reported outcomes in major depressive disorder with suicidal ideation: a real-world data analysis using PatientsLikeMe platform. BMC Psychiatry 2020; 20:384. [PMID: 32703173 PMCID: PMC7376651 DOI: 10.1186/s12888-020-02758-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current analysis utilized data collected via an online patient community platform, PatientsLikeMe (PLM) to compare patient-reported experiences in patients with major depressive disorder (MDD) with suicidal ideation (MDSI) to those with MDD but without suicidal ideation. METHODS PLM members who joined PLM between May-2007 and February-2018 and reported a diagnosis of MDD were included. The MDSI cohort included patients with MDD who reported at least one suicide-related symptom at a severity greater than "none". Demographics, comorbidities, symptoms, and side-effects were compared between MDSI and MDD cohorts. Factors correlated with suicidal ideation (SI) were determined by a random forest procedure. RESULTS Patients in the MDSI cohort (n = 266) were younger (median age, 36 vs 44 years) with an earlier disease onset (before 30 years, 83% vs 71%), and a longer diagnosis latency (median, 4 vs 2 years) vs patients in the MDD cohort (n = 11,963). Majority of patients were women in both cohorts (73% vs 83%). Median number of psychiatric comorbidities was higher in the MDSI cohort (4 vs 3). Unprompted symptoms (e.g., loneliness, feeling of hopelessness, social anxiety, impulsivity, and self-hating thoughts) were more frequent in the MDSI cohort. Hopelessness, loneliness, anhedonia, social anxiety, and younger age were highly correlated with suicidal ideation. CONCLUSIONS This analysis utilized patient-reported data to better understand symptoms, experiences, and characteristics of patients with MDSI compared to patients with MDD. The results identified various risk factors correlated with suicidal ideation that may help guide clinical judgement for patients with MDD who may not voluntarily report suicidal ideation.
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Affiliation(s)
| | - Abigail I. Nash
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Rachna Dayal
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | - Allitia DiBernardo
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
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192
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Carvalho C, Peste F, Marques TA, Knight A, Vicente LM. The Contribution of Rat Studies to Current Knowledge of Major Depressive Disorder: Results From Citation Analysis. Front Psychol 2020; 11:1486. [PMID: 32765345 PMCID: PMC7381216 DOI: 10.3389/fpsyg.2020.01486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Major depressive disorder (MDD) is the most severe depression type and one of the leading causes of morbidity worldwide. Animal models are widely used to understand MDD etiology, pathogenesis, and treatment, but the efficacy of this research for patients has barely been systematically evaluated. Such evaluation is important given the resource consumption and ethical concerns incurred by animal use. We used the citation tracking facilities within Web of Science and Scopus to locate citations of original research papers on rats related to MDD published prior to 2013—to allow adequate time for citations—identified in PubMed and Scopus by relevant search terms. Resulting citations were thematically coded in eight categories, and descriptive statistics were calculated. 178 publications describing relevant rat studies were identified. They were cited 8,712 times. More than half (4,633) of their citations were by other animal studies. 794 (less than 10%) were by human medical papers. Citation analysis indicates that rat model research has contributed very little to the contemporary clinical understanding of MDD. This suggests a misuse of limited funding hence supporting a change in allocation of research and development funds targeting this disorder to maximise benefits for patients.
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Affiliation(s)
- Constança Carvalho
- Centro de Filosofia das Ciências da Universidade de Lisboa (CFCUL), Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Peste
- Centre for Environmental and Marine Studies, Departamento de Biologia, Universidade de Aveiro, Aveiro, Portugal
| | - Tiago A Marques
- Centre for Research into Ecological and Environmental Modelling, Departamento de Biologia Animal, Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Andrew Knight
- Centre for Animal Welfare, University of Winchester, Winchester, United Kingdom
| | - Luís M Vicente
- Centro de Filosofia das Ciências da Universidade de Lisboa (CFCUL), Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
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193
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Chun JY, Sendi MSE, Sui J, Zhi D, Calhoun VD. Visualizing Functional Network Connectivity Difference between Healthy Control and Major Depressive Disorder Using an Explainable Machine-learning Method. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1424-1427. [PMID: 33018257 DOI: 10.1109/embc44109.2020.9175685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Major depressive disorder (MDD) is a complex mental disorder characterized by a persistent sad feeling and depressed mood. Recent studies reported differences between healthy control (HC) and MDD by looking to brain networks including default mode and cognitive control networks. More recently there has been interest in studying the brain using advanced machine learning-based classification approaches. However, interpreting the model used in the classification between MDD and HC has not been explored yet. In the current study, we classified MDD from HC by estimating whole-brain connectivity using several classification methods including support vector machine, random forest, XGBoost, and convolutional neural network. In addition, we leveraged the SHapley Additive exPlanations (SHAP) approach as a feature learning method to model the difference between these two groups. We found a consistent result among all classification method in regard of the classification accuracy and feature learning. Also, we highlighted the role of other brain networks particularly visual and sensory motor network in the classification between MDD and HC subjects.
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194
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Zendehrouh E, Sendi MSE, Sui J, Fu Z, Zhi D, Lv L, Ma X, Ke Q, Li X, Wang C, Abbott CC, Turner JA, Miller RL, Calhoun VD. Aberrant Functional Network Connectivity Transition Probability in Major Depressive Disorder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1493-1496. [PMID: 33018274 PMCID: PMC8233065 DOI: 10.1109/embc44109.2020.9175872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD) is a common and serious mental disorder characterized by a persistent negative feeling and tremendous sadness. In recent decades, several studies used functional network connectivity (FNC), estimated from resting state functional magnetic resonance imaging (fMRI), to investigate the biological signature of MDD. However, the majority of them have ignored the temporal change of brain interaction by focusing on static FNC (sFNC). Dynamic functional network connectivity (dFNC) that explores temporal patterns of functional connectivity (FC) might provide additional information to its static counterpart. In the current study, by applying k-means clustering on dFNC of MDD and healthy subjects (HCs), we estimated 5 different states. Next, we use the hidden Markov model as a potential biomarker to differentiate the dFNC pattern of MDD patients from HCs. Comparing MDD and HC subjects' hidden Markov model (HMM) features, we have highlighted the role of transition probabilities between states as potential biomarkers and identified that transition probability from a lightly- connected state to highly connected one reduces as symptom severity increases in MDD subjects.Index Terms- Major depressive disorder, Dynamic functional network connectivity, Machine learning, Resting- state functional magnetic resonance imaging, Hidden Markov model.
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195
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Tsolaki E, Narr KL, Espinoza R, Wade B, Hellemann G, Kubicki A, Vasavada M, Njau S, Pouratian N. Subcallosal Cingulate Structural Connectivity Differs in Responders and Nonresponders to Electroconvulsive Therapy. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:10-19. [PMID: 32741703 DOI: 10.1016/j.bpsc.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subcallosal cingulate (SCC) activity is associated with treatment response in major depressive disorder (MDD). Using electroconvulsive therapy (ECT) as a treatment model in this exploratory study, we addressed whether pretreatment SCC structural connectivity with corticolimbic-striatal circuitry relates to therapeutic outcome and whether these connectivity patterns change with treatment. METHODS Diffusion magnetic resonance imaging scans were acquired in 43 patients with MDD (mean [SD] age = 41 [13] years; men/women: 18/25) before and within 1 week of completing an ECT index series and in 31 healthy control subjects scanned twice (mean [SD] age = 38 [11] years; men/women: 17/18). Probabilistic tractography from subject-specific anatomically defined SCC seed regions to the ventral striatum (VS), anterior cingulate cortex (ACC), and bilateral medial prefrontal cortex (mPFC) was used to estimate structural connectivity in the target network. RESULTS SCC-mPFC connectivity was lower in responders (>50% symptom improvement) than nonresponders both before (p < .014) (difference 37%-96% left and right hemispheres) and after (p = .023) (difference 100% right hemisphere) treatment. SCC-mPFC connectivity in responders was also decreased compared with control subjects both at baseline (p = .012) and after ECT (p = .006), whereas nonresponders had SCC-right mPFC connectivity similar to that of control subjects. Subjects with MDD also showed decreased SCC-ACC connectivity compared with control subjects (baseline: p < .003, after ECT: p = .001), although SCC-ACC connectivity did not distinguish responders from nonresponders. Bilateral SCC-VS connectivity decreased (11%) with ECT (p = .021) regardless of treatment response. CONCLUSIONS While SCC-ACC connectivity may be a hallmark of MDD compared with control subjects, lower pretreatment SCC-mPFC connectivity in ECT responders (compared with nonresponders and control subjects) suggests that connectivity in this pathway may serve as a potential biomarker of therapeutic outcome and be relevant for treatment selection.
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Affiliation(s)
- Evangelia Tsolaki
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California.
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Antoni Kubicki
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Megha Vasavada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Stephanie Njau
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
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A randomized, crossover comparison of ketamine and electroconvulsive therapy for treatment of major depressive episodes: a Canadian biomarker integration network in depression (CAN-BIND) study protocol. BMC Psychiatry 2020; 20:268. [PMID: 32487236 PMCID: PMC7265624 DOI: 10.1186/s12888-020-02672-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent evidence underscores the utility of rapid-acting antidepressant interventions, such as ketamine, in alleviating symptoms of major depressive episodes (MDE). However, to date, there have been limited head-to-head comparisons of intravenous (IV) ketamine infusions with other antidepressant treatment strategies in large randomized trials. This study protocol describes an ongoing multi-centre, prospective, randomized, crossover, non-inferiority trial comparing acute treatment of individuals meeting diagnostic criteria for a major depressive episode (MDE) with ketamine and electroconvulsive therapy (ECT) on efficacy, speed of therapeutic effects, side effects, and health care resource utilization. A secondary aim is to compare a 6-month maintenance strategy for ketamine responders to standard of care ECT maintenance. Finally, through the measurement of clinical, cognitive, neuroimaging, and molecular markers we aim to establish predictors and moderators of treatment response as well as treatment-elicited effects on these outcomes. METHODS Across four participating Canadian institutions, 240 patients with major depressive disorder or bipolar disorder experiencing a MDE are randomized (1:1) to a course of ECT or racemic IV ketamine (0.5 mg/kg) administered 3 times/week for 3 or 4 weeks. Non-responders (< 50% improvement in Montgomery-Åsberg Depression Rating Scale [MADRS] scores) crossover to receive the alternate treatment. Responders during the randomization or crossover phases then enter the 6-month maintenance phase during which time they receive clinical assessments at identical intervals regardless of treatment arm. ECT maintenance follows standard of care while ketamine maintenance involves: weekly infusions for 1 month, then bi-weekly infusions for 2 months, and finally monthly infusions for 3 months (returning to bi-weekly in case of relapse). The primary outcome measure is change in MADRS scores after randomized treatment as assessed by raters blind to treatment modality. DISCUSSION This multi-centre study will help identify molecular, imaging, and clinical characteristics of patients with treatment-resistant and/or severe MDEs who would benefit most from either type of therapeutic strategy. In addition to informing clinical practice and influencing health care delivery, this trial will add to the robust platform and database of CAN-BIND studies for future research and biomarker discovery. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03674671. Registered September 17, 2018.
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197
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Yamashita H, Fukushima E, Shimomura K, Hirose H, Nakayama K, Orimo N, Mao W, Katsuta N, Nishimon S, Ohnuma T. Use of skin advanced glycation end product levels measured using a simple noninvasive method as a biological marker for the diagnosis of neuropsychiatric diseases. Int J Methods Psychiatr Res 2020; 29:e1824. [PMID: 32323917 PMCID: PMC7301278 DOI: 10.1002/mpr.1824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/21/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The accumulation of advanced glycation end products (AGEs) may be involved in the pathophysiology of several neuropsychiatric diseases. In this study, the skin AGEs level of several neuropsychiatric diseases was assessed with a simple noninvasive method. Moreover, whether skin AGE level can be used as a biomarker for the diagnosis of these diseases was evaluated. METHODS A total of 27 patients with schizophrenia, 26 with major depressive disorder, and 10 with major neurocognitive disorders (MNDs), such as Alzheimer's disease or dementia with Lewy body, as well as 26 healthy controls were enrolled in this study. The skin AGE levels of the patients were assessed with an AGE scanner, a fluorometric method used to assay skin AGE levels. RESULTS One-way analysis of covariance was performed after adjusting for significant covariates, including age. Although the group with MNDs had higher skin AGE levels than the other groups, the main effect of diagnosis did not significantly affect the skin AGE levels of the groups. CONCLUSIONS Skin AGE levels in neuropsychiatric diseases with mild symptoms did not significantly differ. Further large-scale studies using a simple noninvasive method for the early detection and treatment of MNDs must be conducted.
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Affiliation(s)
- Hiroki Yamashita
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Eriko Fukushima
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kaori Shimomura
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hitoki Hirose
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ken Nakayama
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Narihiro Orimo
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Wanyi Mao
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Narimasa Katsuta
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Shohei Nishimon
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Tohru Ohnuma
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Juntendo University, Faculty of Medicine, Tokyo, Japan
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198
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Kutzer T, Dick M, Scudamore T, Wiener M, Schwartz T. Antidepressant efficacy and side effect burden: an updated guide for clinicians. Drugs Context 2020; 9:dic-2020-2-2. [PMID: 32523610 PMCID: PMC7255467 DOI: 10.7573/dic.2020-2-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Antidepressant treatment has been evolving and changing since the 1950s following the discovery of the classic antidepressant treatments including tricyclic antidepressants and monoamine oxidase inhibitors. The heterogeneity of the disorder became apparent in the beginning when individuals remained symptomatic despite medication compliance. This spurred further research in order to understand the neurobiology underlying the disorder. Subsequently, newer medications were designed to target specific neurotransmitters and areas of the brain involved in symptom development and maintenance. Our original review article looked at both classic and modern antidepressant medications used in the treatment of major depressive disorder. This manuscript is an update to the original review and serves to provide clinicians with information about novel antidepressant medications, augmentation strategies with atypical antipsychotics, over-the-counter medications, as well as nonpharmaceutical treatments that should be considered when treating each individual patient who remains symptomatic despite treatment efforts.
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Affiliation(s)
- Tatum Kutzer
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michelle Dick
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Trevor Scudamore
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mark Wiener
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Thomas Schwartz
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
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de Almeida RF, Pocharski CB, Rodrigues ALS, Elisabetsky E, Souza DO. Guanosine fast onset antidepressant-like effects in the olfactory bulbectomy mice model. Sci Rep 2020; 10:8429. [PMID: 32439951 PMCID: PMC7242421 DOI: 10.1038/s41598-020-65300-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
The treatment of major depressive disorder (MDD) is still a challenge. In the search for novel antidepressants, glutamatergic neuromodulators have been investigated as possible fast-acting antidepressants. Innovative studies suggest that the purine cycle and/or the purinergic signaling can be dysregulated in MDD, and the endogenous nucleoside guanosine has gained attention due to its extracellular effects. This study aimed to verify if guanosine produces fast-onset effects in the well-validated, reliable and sensitive olfactory bulbectomy (OBX) model of depression. The involvement of the mTOR pathway, a key target for the fast-onset effect of ketamine, was also investigated. Results show that a single i.p. injection of guanosine, or ketamine, completely reversed the OBX-induced anhedonic-like behavior 24 or 48 h post treatment, as well as the short-term recognition memory impairment 48 h post treatment. The antidepressant-like effects of guanosine and ketamine were completely abolished by rapamycin. This study shows, for the first time, that guanosine, in a way similar to ketamine, is able to elicit a fast antidepressant response in the OBX model in mice. The results support the notion that guanosine represents a new road for therapeutic improvement in MDD.
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Affiliation(s)
- Roberto Farina de Almeida
- Departamento de Ciências Biológicas, Programa de Pós-Graduação em Ciências Biológicas, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, Brazil.
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Camila Barbosa Pocharski
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ana Lúcia S Rodrigues
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Elaine Elisabetsky
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Diogo O Souza
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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The Association Between Vascular Inflammation and Depressive Disorder. Causality, Biomarkers and Targeted Treatment. Pharmaceuticals (Basel) 2020; 13:ph13050092. [PMID: 32408603 PMCID: PMC7281196 DOI: 10.3390/ph13050092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
Diabetes, obesity, atherosclerosis, and myocardial infarction are frequently co-morbid with major depressive disorder. In the current review, it is argued that vascular inflammation is a factor that is common to all disorders and that an endothelial dysfunction of the blood-brain barrier could be involved in the induction of depression symptoms. Biomarkers for vascular inflammation include a high plasma level of C-reactive protein, soluble cell-adhesion molecules, von Willebrand factor, aldosterone, and proinflammatory cytokines like interleukin-6 or tumor necrosis factor α. A further possible biomarker is flow-mediated dilation of the brachial artery. Treatment of vascular inflammation is expected to prevent or to reduce symptoms of depression. Several tentative treatments for this form of depression can be envisioned: eicosapentaenoic acid (EPA), valproate, Vagus-nerve stimulation, nicotinic α7 agonists, and agonists of the cannabinoid CB2-receptor.
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