Neurobiologie der Anhedonie: Zur Pathophysiologie eines bedeutenden Symptoms der depressiven Störung

Optimizing Treatment for Major Depressive Disorder in Adolescents: The Impact of Intradermal Acupuncture - A Randomized Controlled Trial Protocol

Background

Major depressive disorder (MDD) exhibits a pronounced occurrence among adolescents, aligning closely with the lifetime prevalence rate of 16.6% observed in adults. It is difficult to treat and prone to recurrence. Acupuncture has shown potential in enhancing treatment effectiveness. Nonetheless, there is a lack of research on the use of intradermal acupuncture (IA) in treating adolescent MDD.

Methods

This study is a double-blind, randomized controlled trial. A cohort of 120 participants will be assigned randomly to three distinct groups, namely a Selective Serotonin Reuptake Inhibitors (SSRIs)-only group, a sham intradermal acupuncture combined with SSRIs (SIA) group, and an active intradermal acupuncture combined with SSRIs (AIA) group. Hamilton Depression Rating Scale will serve as the primary outcome, while Patient Health Questionnaire-9, Self-Rating Depression Scale, Pittsburgh Sleep Quality Index, and Short Form 36 Questionnaire will serve as secondary outcomes in assessing the amelioration of depressive symptoms in patients. These data will be analyzed using SPSS26.0 software.

Results

We will assess the efficacy and safety of IA for MDD using commonly employed clinical psychiatric scales.

Conclusion

The efficacy of IA in treating adolescent MDD may be demonstrated in this study, suggesting its potential for optimizing MDD treatment schemes.

Trial Registration

ClinicalTrials.gov Identifier: NCT05832619 (April 27, 2023).

[Clinical and therapeutic perspectives of agomelatine (valdoxan) in the treatment of anhedonia in patients with endogenous depressions]

OBJECTIVE

To analyze the therapeutic effect of valdoxan on symptoms of anhedonia in patients with endogenous depressions and to develop indications for its use.

MATERIAL AND METHODS

Authors examined 30 women, mean age 35,9 years with anhedonic depression (ICD-10 items F31.3-4, F33.1-2, F20.4). Valdoxan was administered in average daily dose from 25.8 to 45.8 mg during 30 days. Patient's status was assessed on 0, 7, 14 and 30th days, using clinical and psychometric (HAMD-21, HADS, SHAPS and UKU scales) methods. The reduction of scores was used as a measure of therapeutic effect designated as «mild», «moderate», «good» and «marked».

RESULTS

Antianhedonic effect of valdoxan on 30th day was superior to thymoleptic and anxiolytic effects of this drug (91.5 versus 82.2 and 76.9%). The marked effect was identified already on 14th day and enhanced to 30th day. The best effect was seen in depression of moderate severity. Single autonomic side-effects of the treatment were observed.

CONCLUSION

The course treatment of anhedonic depressions with valdoxan should be considered as preferable and highly effective method that provides a dominative antianhedonic effect in the spectrum of antidepressive properties of the drug. Good and marked effects have been achieved in 96.7% of patients. The intensity and rate of its formation, good tolerability allow to tailor indications of valdoxan basing on the psychopathological characteristics of gedonic disorders.

[Deep brain stimulation as possible alternative for therapy resistant depression]

There are many fearful prejudices and misunderstandings on the method of deep brain stimulation (DBS), especially in its application to neuropsychiatric diseases. Using the example of the treatment of resistant depression this article will discuss the current state of DBS in an attempt to overcome some of the prejudices and to elaborate on its potential development. The DBS is a straightforward method and has been used clinically for more than 12 years to treat some neurological diseases, such as tremor in Parkinson's disease and other movement disorders. More than 100,000 patients have already been treated worldwide using DBS which is a procedure in which electrodes are placed bilaterally in certain brain regions where they can modulate disease-related dysfunctions.

Anti-anhedonic effect of deep brain stimulation of the prefrontal cortex and the dopaminergic reward system in a genetic rat model of depression: an intracranial self-stimulation paradigm study

BACKGROUND

One of the two core symptoms of major depression (MD), whether uni- or bipolar, is the inability to experience pleasure, suggested to be triggered by dysregulation within the brain reward system. In recent years, deep brain stimulation (DBS) has evolved as a potential tool to modulate pathological neural activity; stimulation of the subgenual cingulate (Cg25) has been shown to reduce depressive symptoms, including anhedonia. In rodents, the ventromedial prefrontal cortex (vmPFC) is likely to represent the correlate of Cg25 and accordingly, stimulation of vmPFC reduces anhedonia-like behavior in rats.

OBJECTIVE/HYPOTHESIS

The present study addresses the question of whether the anti-anhedonic effect of vmPFC-DBS is mediated by the brain reward system.

METHODS

Rats of the Flinders Sensitive Line (FSL), a validated genetic animal model of depression, and its controls, the Flinders Resistant Line (FRL), were stimulated in the vmPFC and tested in the forced swim test (FST), sucrose consumption test (SCT) and the intracranial self-stimulation (ICSS) paradigm. The curve-shift paradigm of ICSS was used in combination with vmPFC-DBS, d-amphetamine and fluoxetine to quantify reward-facilitating or -attenuating treatment effects.

RESULTS

Our findings support anti-depressive efficacy of vmPFC-DBS with respect to despair- and anhedonia-like behavior, as shown in the FST and SCT, respectively. However, DBS did not elicit reward-facilitating or reward-attenuating effects on ICSS behavior.

CONCLUSION

These data suggest that it is unlikely that the anti-anhedonic effect of vmPFC-DBS depends on the mesolimbic dopaminergic reward system.