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Pastuszak M, Cubała WJ, Kwaśny A, Mechlińska A. The Search for Consistency in Residual Symptoms in Major Depressive Disorder: A Narrative Review. J Pers Med 2024; 14:828. [PMID: 39202019 PMCID: PMC11355381 DOI: 10.3390/jpm14080828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
Residual symptoms are prevalent in major depressive disorder (MDD), encompassing a wide spectrum of symptoms such as sleep disturbances, changes in weight and appetite, cognitive impairment, and anxiety. These symptoms consistently impair daily functioning, diminish quality of life, and forecast disease relapse. Despite their clinical significance, residual symptoms lack a unified definition, potentially leading to confusion with treatment-emergent symptoms and ambiguity across studies, thereby hindering the generalizability of research findings. While some research identifies insomnia and mood disturbances as critical indicators, other studies emphasize different symptoms or find no significant correlation. Inconsistencies in defining residual symptoms, as well as methodological differences across studies, contribute to these conflicting results. While clinicians focus on alleviating negative symptoms to improve functional status, patients often prioritize achieving positive affect and overall well-being as essential components of successful treatment. It necessitates a comprehensive approach to patient care in depression. This review explores the phenomenon of residual symptoms in MDD, focusing on the ambiguity in definitions, clinical characteristics, and their impact on long-term outcomes. The lack of a standardized regulatory or academic definition for residual symptoms leads to varied interpretations among clinicians, underscoring the need for standardized terminology to guide effective treatment strategies and future research.
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Affiliation(s)
| | | | - Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.P.); (W.J.C.); (A.M.)
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Hein M, Wacquier B, Conenna M, Lanquart JP, Point C. Risk of Comorbid Insomnia Disorder Associated with Major Depression in Apneic Patients: A Cross-Sectional Study. Clocks Sleep 2024; 6:389-401. [PMID: 39189193 PMCID: PMC11348371 DOI: 10.3390/clockssleep6030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/20/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
Given the limitations of available studies, the objective of this study was to explore the role played by current and remitted major depression in the occurrence of comorbid insomnia disorder for apneic patients. Data from 1488 apneic patients were extracted from the medical reports of polysomnographic recordings available in the database of the Sleep Laboratory. The presence of comorbid insomnia disorder in these apneic patients was defined based on the diagnostic criteria of the American Academy of Sleep Medicine Work Group. The risk of comorbid insomnia disorder associated with current or remitted major depression in apneic patients was investigated using multivariate logistic regression models. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that remitted and current major depression were significantly associated with the occurrence of comorbid insomnia disorder in apneic patients. The findings of this study seem to indicate that comorbid insomnia disorder could be a residual symptom and a marker of major depression in apneic patients, which justifies the establishment of an adequate treatment for major depressive episodes and their potential residual symptoms to allow the better management of comorbid insomnia disorder and the better prevention of its potential negative consequences in this particular subpopulation.
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Affiliation(s)
- Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Brussels, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Matteo Conenna
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
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Matsuda E, Kikutani M. Impacts of sleep disturbance and work-related life stress on depression among Japanese and Chinese workers. PLoS One 2024; 19:e0305936. [PMID: 38935694 PMCID: PMC11210821 DOI: 10.1371/journal.pone.0305936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/07/2024] [Indexed: 06/29/2024] Open
Abstract
The present study investigated how life stress and sleep disturbance impact depressive symptoms among Chinese (N = 185) and Japanese (N = 464) workers. Based on a hypothesis that sleep disturbance can cause depression, a statistical model is established, expecting that work-related life stress indirectly increases depressive symptoms by worsening sleep disturbance rather than initiating depression directly. The study also examined the buffering effects of social support on depression. The extent of depressive symptoms, sleep disturbance symptoms (insomnia, hypersomnia, and nightmare), work-related stressors, and available social support were measured. The result revealed that the extent of depression was equivalent for both groups, but the Chinese reported more stress, less social support, and more severe sleep disturbance symptoms than the Japanese. Despite those differences, the statistical model fitted both groups well, suggesting that addressing sleep disturbance at the earliest opportunity can effectively prevent depression onset for workers.
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Affiliation(s)
- Eiko Matsuda
- Department of Social Psychology, Faculty of Sociology, Toyo University, Bunkyo-ku, Tokyo, Japan
| | - Mariko Kikutani
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Nygren A, Brenner P, Brandt L, Karlsson P, Eloranta S, Reutfors J. Trends in hypnotic drug use in depression 2007-2017: A Swedish population-based study. J Sleep Res 2024:e14267. [PMID: 38874288 DOI: 10.1111/jsr.14267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 03/01/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Insomnia is a common feature of depression; however, depression treatment guidelines provide limited recommendations regarding hypnotic drugs. Few studies have thoroughly investigated the use of hypnotic drugs in depression. In this cohort study using national Swedish registers, we included all patients ≥18 years with incident unipolar depression during 2007-2017. Patients were followed for 3 years, noting the annual and quarterly prevalence of hypnotic drug use from prescription fills. Prevalence ratios (PR) comparing 2017 to 2007 were calculated with 95% confidence intervals (CI). A total of 222,077 patients with depression were included (mean age 41 years, 59% women). In the year following diagnosis, 44.1% used any hypnotic drug in 2017, compared with 46.7% in 2007 (PR 0.94, 95% CI 0.92-0.97). The most commonly used drugs were Z-drugs (zopiclone, zolpidem, and zaleplon) with a prevalence of 27.6% in 2017 and 35.6% in 2007 (PR 0.78, 95% CI 0.75-0.80). Melatonin use increased sharply to 12.0% in 2017 from 0.4% in 2007 (PR 28.9, 95% CI 23.5-35.7). Hypnotic drug use was most prevalent in the first two quarters after diagnosis; however, after 3 years, the quarterly prevalence was still 19.2%. Hypnotics were more common among women, older patients, those with somatic comorbidities, more severe depression, or a history of suicide attempt. Evidence from this large register-based study demonstrates that hypnotics were used to a large extent in depression in Sweden 2007-2017. Z-drugs use declined and melatonin use increased dramatically. Hypnotic drug use remained high even 3 years after diagnosis.
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Affiliation(s)
- Adam Nygren
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - P Brenner
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - L Brandt
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - P Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - J Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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Matsumoto Y, Sakurai H, Aoki Y, Takaesu Y, Okajima I, Tachimori H, Murao M, Maruki T, Tsuboi T, Watanabe K. Assessing the Quick Inventory of Depressive Symptomatology Self-Report scores to predict continuous employment in mood disorder patients. Front Psychiatry 2024; 15:1321611. [PMID: 38694002 PMCID: PMC11062021 DOI: 10.3389/fpsyt.2024.1321611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/04/2024] [Indexed: 05/03/2024] Open
Abstract
Objective Depression significantly impacts the job performance and attendance of workers, leading to increased absenteeism. Predicting occupational engagement for individuals with depression is of paramount importance. This study aims to determine the cut-off score which predicts continuous employment for patients with mood disorders using the Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR). Methods In a prospective observational trial conducted in Tokyo, 111 outpatients diagnosed with either major depressive disorder or bipolar depression were enrolled. Their employment statuses of these participants were tracked over a six-month period after their QIDS-SR scores were recorded. Based on their employment trajectories, participants were categorized into either continuous or non-continuous employment groups. Binary logistic regression was applied to examine the relationship between the QIDS-SR scores and employment outcomes, with adjustments for age, gender, and psychiatric diagnoses. Receiver operating characteristic curves were utilized to identify the optimal QIDS-SR cut-off values for predicting continuous employment. Findings Binary logistic regression demonstrated that a lower score on the QIDS-SR was linked to an elevated likelihood of continuous employment (adjusted odds ratio 1.15, 95% CI: 1.06-1.26, p=0.001). The optimal cut-off point, determined by the Youden Index, was 10/11, showcasing a 63% sensitivity and 71% specificity. Conclusion The results emphasize the potential of the QIDS-SR as a prognostic instrument for predicting employment outcomes among individuals with depressive disorders. These findings further underscore the importance of managing depressive symptoms to mild or lower intensities to ensure ongoing employment.
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Affiliation(s)
- Yasuyuki Matsumoto
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Okinawa, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Masami Murao
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Taku Maruki
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
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Palmer EOC, Ker S, Rentería ME, Carmody T, Rush AJ. Psychometric evaluation and linking of the PHQ-9, QIDS-C, and VQIDS-C in a real-world population with major depressive disorder. Neuropsychiatr Dis Treat 2024; 20:671-687. [PMID: 38559772 PMCID: PMC10981376 DOI: 10.2147/ndt.s444223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Major depressive disorder (MDD) is a leading cause of disability worldwide. An accurate assessment of depressive symptomology is crucial for clinical management and research. This study assessed the convergent validity, reliability, and total scale score interconversion across the 9-item Patient Health Questionnaire (PHQ-9) self-report, the 16-item Quick Inventory of Depressive Symptomatology-clinician report (QIDS-C) (two widely used clinical ratings) and the 5-item Very Brief Quick Inventory of Depressive Symptoms-clinician report (VQIDS-C), which evaluate the core features of MDD. Patients and Methods This study leveraged electronic health record (EHR)-derived, de-identified data from the NeuroBlu Database (Version 23R1), a longitudinal behavioural health real-world platform. Classical Test Theory (CTT) and Item Response Theory (IRT) analyses were used to evaluate the reliability, validity of, and conversions between the scales. The Test Information Function (TIF) was calculated for each scale, with greater test information reflecting higher precision and reliability in measuring depressive symptomology. IRT was also used to generate conversion tables so that total scores on each scale could be compared to the other. Results The study sample (n = 2,156) had an average age of 36.4 years (standard deviation [SD] = 13.0) and 59.7% were female. The mean depression scores for the PHQ-9, QIDS-C, and VQIDS-C were 12.9 (SD = 6.6), 12.0 (SD = 4.9), and 6.18 (SD = 3.2), respectively. The Cronbach's alpha coefficients for PHQ-9, QIDS-C, and VQIDS-C were 0.9, 0.8, and 0.7, respectively, suggesting acceptable internal consistency. PHQ-9 (TIF = 30.3) demonstrated the best assessment of depressive symptomology, followed by QIDS-C (TIF = 25.8) and VQIDS-C (TIF = 17.7). Conclusion Overall, PHQ-9, QIDS-C, and VQIDS-C appear to be reliable and convertible measures of MDD symptomology within a US-based adult population in a real-world clinical setting.
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Affiliation(s)
| | | | | | - Thomas Carmody
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Duke University School of Medicine, Duke University School of Medicine, Durham, NC, USA
- Clinical sciences, Duke-National University of Singapore, Singapore
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Chen Z, Xiong J, Ma H, Hu Y, Bai J, Wu H, Wang Y. Network analysis of depression and anxiety symptoms and their associations with mobile phone addiction among Chinese medical students during the late stage of the COVID-19 pandemic. SSM Popul Health 2024; 25:101567. [PMID: 38524176 PMCID: PMC10958643 DOI: 10.1016/j.ssmph.2023.101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 03/26/2024] Open
Abstract
Network analysis provides a novel approach to discovering associations between mental disorders at the symptom level. This study aimed to examine the characteristics of the network of depression and anxiety symptoms and their associations with mobile phone addiction (MPA) among Chinese medical students during the late stage of the COVID-19 pandemic. A total of 553 medical students were included. Depression and anxiety symptoms and MPA were measured by the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the Mobile Phone Addiction Index (MPAI), respectively. Central and bridge symptoms were identified with centrality indices and bridge centrality indices. Network stability was examined using the case-dropping procedure. "Uncontrollable worry", "restlessness" and "nervousness" were the central symptoms in the depression and anxiety network. "Restlessness" and "motor" were the most central bridge symptoms linking depression and anxiety. "Concentration", "anhedonia" and "sleep" were most strongly associated with MPA. "Uncontrollable worry", "restlessness", "nervousness," and "motor" may be the symptoms for interventions to target in medical students with comorbid depression and anxiety. From a network perspective, depressive symptoms may be more important than anxiety symptoms in medical students with MPA.
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Affiliation(s)
- Zhihan Chen
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Jiexi Xiong
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Hongfei Ma
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Yunan Hu
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Junni Bai
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Hui Wu
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
| | - Yang Wang
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, PR China
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Zhou J, Zhou J, Feng Z, Feng L, Xiao L, Chen X, Yang J, Feng Y, Wang G. Identifying the core residual symptom in patients with major depressive disorder using network analysis and illustrating its association with prognosis: A study based on the national cohorts in China. Gen Hosp Psychiatry 2024; 87:68-76. [PMID: 38325144 DOI: 10.1016/j.genhosppsych.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To identify the core residual symptom of MDD and assess its relationship with patients' long-term outcomes. METHOD All patients were administered antidepressants during the acute phase and treated continuously. The 521 patients remitted at month 6 of a multicenter prospective project were included. Remission was defined as a Quick Inventory of Depressive Symptoms-Self-Report total score of ≤5. Functional impairments were measured with the Sheehan Disability Scale, quality of life with the Quality of Life Enjoyment and Satisfaction Questionnaire - short form, and family burden with the Family Burden Scale of Disease. Visits were scheduled at baseline, weeks 2, 8, 12, and month 6. RESULTS Difficulty with concentration/decision making was the core residual symptom of MDD, determined with the centrality measure of network analysis. It was positively associated with functional impairments and family burden (r = 0.35, P < 0.01 and r = 0.31, P < 0.01, respectively) and negatively associated with life satisfaction (r = -0.29, P < 0.01). The exhibition of this residual symptom was associated with a family history of psychiatric disorders (OR = 2.610 [1.242-5.485]). CONCLUSIONS The core residual symptom of MDD, difficulty with concentration/decision making, is associated with poorer social functioning, heavier family burden, and lower life satisfaction. Early detection and intervention of this symptom may be beneficial. CLINICAL TRIALS REGISTRATION NUMBER (Chinese Clinical Trials.gov identifier) ChiCTR-OOC-17012566 and ChiCTR-INR-17012574.
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Affiliation(s)
- Jingjing Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zizhao Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Tonge NA, Miller JP, Kharasch ED, Lenze EJ, Rodebaugh TL. An investigation of the potential clinical utility of critical slowing down as an early warning sign for recurrence of depression. J Behav Ther Exp Psychiatry 2024; 82:101922. [PMID: 37956479 DOI: 10.1016/j.jbtep.2023.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Much of the burden of depressive illness is due to relapses that occur after treatment into remission. Prediction of an individual's imminent depressive relapse could lead to just-in-time interventions to prevent relapse, reducing depression's substantial burden of disability, costs, and suicide risk. Increasingly strong relationships in the form of autocorrelations between depressive symptoms, a signal of a phenomenon described as critical slowing down (CSD), have been proposed as a means of predicting relapse. METHODS In the current study, four participants in remission from depression, one of whom relapsed, responded to daily smartphone surveys with depression symptoms. We used p-technique factor analysis to identify depression factors from over 100 survey responses. We then tested for the presence of CSD using time-varying vector autoregression and detrended fluctuation analysis. RESULTS We found evidence that CSD provided an early warning sign for depression in the participant who relapsed, but we also detected false positive indications of CSD in participants who did not relapse. Results from time-varying vector autoregression and detrended fluctuation analysis were not in agreement. LIMITATIONS Limitations include use of secondary data and a small number of participants with daily responding to a subset of depression symptoms. CONCLUSIONS CSD provides a compelling framework for predicting depressive relapse and future research should focus on improving detection of early warning signs reliably. Improving early detection methods for depression is clinically significant, as it would allow for the development of just-in-time interventions.
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Affiliation(s)
- Natasha A Tonge
- Department of Psychology & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA.
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Evan D Kharasch
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Thomas L Rodebaugh
- Department of Psychology & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
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Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Ando M, Noda A, Ozaki N. LPS and its relationship with subjective-objective discrepancies of sleep onset latency in patients with psychiatric disorders. Sci Rep 2023; 13:22637. [PMID: 38114534 PMCID: PMC10730694 DOI: 10.1038/s41598-023-49261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Subjective-objective discrepancies in sleep onset latency (SOL), which is often observed among psychiatric patients, is attributed partly to the definition of sleep onset. Recently, instead of SOL, latency to persistent sleep (LPS), which is defined as the duration from turning out the light to the first consecutive minutes of non-wakefulness, has been utilized in pharmacological studies. This study aimed to determine the non-awake time in LPS that is most consistent with subjective sleep onset among patients with psychiatric disorders. We calculated the length of non-awake time in 30-s segments from lights-out to 0.5-60 min. The root mean square error was then calculated to determine the most appropriate length. The analysis of 149 patients with psychiatric disorders showed that the optimal non-awake time in LPS was 12 min. On the other hands, when comorbid with moderate or severe obstructive sleep apnea (OSA), the optimal length was 19.5 min. This study indicates that 12 min should be the best fit for the LPS non-awake time in patients with psychiatric disorders. When there is comorbidity with OSA, however, a longer duration should be considered. Measuring LPS minimizes discrepancies in SOL and provides important clinical information.
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Affiliation(s)
- Keita Kawai
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ippei Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Motoo Ando
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Aichi, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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11
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Whiston A, Igou ER, Fortune DG, Semkovska M. Longitudinal interactions between residual symptoms and physiological stress in the remitted symptom network structure of depression. Acta Psychol (Amst) 2023; 241:104078. [PMID: 37944268 DOI: 10.1016/j.actpsy.2023.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/16/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Residual symptoms and stress are amongst the most reliable predictors of relapse in remitted depression. Standard methodologies often preclude continuous stress sampling or the evaluation of complex symptom interactions. This limits knowledge acquisition relative to the day-to-day interactions between residual symptoms and stress. The study aims to explore the interactions between physiological stress and residual symptoms network structure in remitted depression. Twenty-two individuals remitted from depression completed baseline, daily diary (DD), and post-DD assessments. Self-reported stress and residual symptoms were measured at baseline and post-DD. Daily diaries required participants to use a wearable electrodermal activity (EDA) device during waking hours and complete residual symptom measures twice daily for 3-weeks. Two-step multilevel vector auto-regression models were used to estimate contemporaneous and dynamic networks. Depressed mood and concentration problems were central across networks. Skin conductance responses (SCRs), suicide, appetite, and sleep problems were central in the temporal and energy loss in the contemporaneous network. Increased SCRs predicted decreased energy loss. Residual symptoms and stress showed bi-directional interactions. Overall, depressed mood and concentration problems were consistently central, thus potentially important intervention targets. Non-obtrusive bio-signal measures should be used to provide the clinical evidence-base for modelling the interactions between depressive residual symptoms and stress. Practical implications are discussed throughout related to focusing on symptom-specific interactions in clinical practice, simultaneously reducing residual symptom and stress occurrences, EDA as pioneering signal for stress detection, and the central role of specific residual symptoms in remitted depression.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Co., Limerick, Ireland.
| | - Eric R Igou
- Department of Psychology, University of Limerick, Co., Limerick, Ireland
| | - Dònal G Fortune
- Department of Psychology, University of Limerick, Co., Limerick, Ireland
| | - Maria Semkovska
- DeFREE Research Unit, Department of Psychology, University of Southern Denmark, Denmark
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12
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Kwaśny A, Włodarczyk A, Dywel A, Szarmach J, Strandberg O, Cubała WJ. Residual insomnia in major depressive disorder: a systematic review. Front Psychiatry 2023; 14:1190415. [PMID: 37398584 PMCID: PMC10312086 DOI: 10.3389/fpsyt.2023.1190415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The ultimate goal in major depressive disorder (MDD) treatment is recovery. A proportion of MDD patients with formal remission experience persistent difficulties, which impair their daily functioning. Residual insomnia is one of the most common residual symptoms. Patients with residual insomnia experience relapse significantly earlier and have a poor prognosis. Little is known about possible ways of treatment and what subtype of insomnia is mostly reported. Methods A systematic literature review was carried out in PubMed and Web of Science to synthesize the current status of knowledge about effective treatment methods and insomnia subtypes in residual insomnia in MDD. Results A few non-pharmacological treatment methods e.g., Cognitive Behavioral Therapy for Insomnia (CBT-I), Mindfulness-Based Cognitive Therapy (MBCT), behavioral activation (BA) and pharmacological methods (gabapentin, clonazepam) have proven to mitigate residual insomnia. Cognitive Behavioral Therapy for Depression (CBT-D) ameliorates insomnia complaints to a limited extent. Mid-nocturnal insomnia is the most common residual insomnia subtype in MDD patients. Conclusion Residual insomnia is a very common complaint and most often appears as mid-nocturnal insomnia. Scarce data points out the benefits from pharmacotherapy, psychotherapy, and BA. More research is needed.
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Flint AJ, Bingham KS, Alexopoulos GS, Marino P, Mulsant BH, Neufeld NH, Rothschild AJ, Voineskos AN, Whyte EM, Meyers BS. Predictors of relapse of psychotic depression: Findings from the STOP-PD II randomized clinical trial. J Psychiatr Res 2023; 157:285-290. [PMID: 36535116 DOI: 10.1016/j.jpsychires.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/26/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
Psychotic depression has a high rate of relapse. The study aims were to identify a prediction model of risk of relapse of psychotic depression and examine whether predictors moderated the effect of treatment on relapse. One hundred and twenty-six men and women aged 18-85 years, who experienced sustained remission or near-remission of psychotic depression with sertraline plus olanzapine, participated in a 36-week randomized controlled trial that compared sertraline plus olanzapine with sertraline plus placebo in preventing relapse (NCT01427608). Cox regression analyses were performed to identify significant predictors of relapse and to model the combined role of significant predictors. Concordance statistic was calculated to determine the accuracy of the best fit multivariable models in predicting relapse. Finally, interaction terms were tested for each significant predictor to examine whether they moderated the effect of treatment on risk of relapse. Lifetime number of depressive episodes, severity of residual depressive symptoms at the time of randomization, and psychomotor disturbance both at acute enrollment when participants were depressed and at the time of randomization predicted risk of relapse. Multivariable models had 69-70% accuracy in predicting relapse. Psychomotor disturbance was associated with increased risk of relapse in the sertraline plus olanzapine group compared with sertraline plus placebo, whereas the other predictors did not moderate the effect of treatment on relapse. Future research is needed to determine whether a combination of clinical and biological variables can further increase the accuracy of prediction of relapse of psychotic depression.
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Affiliation(s)
- Alastair J Flint
- Centre for Mental Health, University Health Network, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Kathleen S Bingham
- Centre for Mental Health, University Health Network, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, NY, USA
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, NY, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicholas H Neufeld
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Anthony J Rothschild
- University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, USA
| | - Aristotle N Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, USA
| | - Barnett S Meyers
- Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, NY, USA
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Kubo K, Sakurai H, Tani H, Watanabe K, Mimura M, Uchida H. Predicting relapse from the time to remission during the acute treatment of depression: A re-analysis of the STAR*D data. J Affect Disord 2023; 320:710-715. [PMID: 36208688 DOI: 10.1016/j.jad.2022.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting relapse during maintenance treatment for depression is challenging. The objective of this analysis was to investigate the association between the time taken to achieve remission in the acute phase, and the subsequent relapse rate or time to relapse using the Sequenced Treatment Alternatives to Relieve Depression dataset. METHOD Data of 1296 outpatients with nonpsychotic depression who entered a 12-month naturalistic follow-up period after achieving remission with citalopram for up to 14 weeks were analyzed. One-way analysis of variance and the Jonckheere-Terpstra trend test were performed to compare the relapse rates and days to relapse during the follow-up period among those who achieved remission at weeks 2, 4, 6, 9, 12, and 14. Remission and relapse were defined as scores of ≤5 and ≥11, respectively, on the 16-Item Quick Inventory of Depressive Symptomatology and Self-Report. RESULTS The relapse rates were significantly different among those who achieved remission each week (F(5, 1087) = 4.995, p < 0.001). The lowest and highest relapse rates were observed in those who achieved remission at weeks 4 (25.7 %) and 12 (42.4 %), respectively, with a significant difference (p = 0.006). There was also a significant negative trend between the weeks taken to achieve remission and the days to relapse (z = -6.13, p < 0.001). CONCLUSIONS Patients with depression who show a faster response to antidepressant treatment are more likely to maintain remission in the long term. This finding suggests that, to prevent relapse, close attention should be paid to patients who require a relatively long time to achieve remission.
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Affiliation(s)
- Kaoruhiko Kubo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan.
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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15
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Epperson CN, Rubinow DR, Meltzer-Brody S, Deligiannidis KM, Riesenberg R, Krystal AD, Bankole K, Huang MY, Li H, Brown C, Kanes SJ, Lasser R. Effect of brexanolone on depressive symptoms, anxiety, and insomnia in women with postpartum depression: Pooled analyses from 3 double-blind, randomized, placebo-controlled clinical trials in the HUMMINGBIRD clinical program. J Affect Disord 2023; 320:353-359. [PMID: 36191643 DOI: 10.1016/j.jad.2022.09.143] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/26/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Brexanolone is currently the only treatment specifically approved for postpartum depression (PPD) in the United States, based on the results from one Phase 2 and two Phase 3 double-blind, randomized, controlled trials in the HUMMINGBIRD program. METHODS Adults with PPD randomized to a 60-h infusion of brexanolone 90 μg/kg/h (BRX90) or placebo from the 3 trials were included in these post hoc analyses. Data on change from baseline (CFB) in the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score, HAMD-17 Anxiety/Somatization and Insomnia subscales, and Clinical Global Impression of Improvement (CGI-I) scale were pooled. Response rates for HAMD-17 (≥50 % reduction from baseline) and CGI-I (score of 1 or 2) scales and time to response were analyzed. RESULTS Patients receiving BRX90 (n = 102) versus placebo (n = 107) achieved a more rapid HAMD-17 response (median, 24 vs 36 h; p = 0.0265), with an Hour-60 cumulative response rate of 81.4 % versus 67.3 %; results were similar for time to CGI-I response (median, 24 vs 36 h; p = 0.0058), with an Hour-60 cumulative response rate of 81.4 % versus 61.7 %. CFB in HAMD-17 Anxiety/Somatization and Insomnia subscales also favored BRX90 versus placebo, starting at Hour 24 through Day 30 (all p < 0.05), and response rates for both subscales were higher with BRX90. LIMITATIONS The study was not powered to assess exploratory outcomes. CONCLUSIONS Brexanolone was associated with rapid improvement in depressive symptoms and symptoms of anxiety and insomnia compared with placebo in women with PPD. These data continue to support the use of brexanolone to treat adults with PPD.
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Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America.
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Kristina M Deligiannidis
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States of America; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Robert Riesenberg
- Atlanta Center for Medical Research, Atlanta, GA, United States of America
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America
| | - Kemi Bankole
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Ming-Yi Huang
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Haihong Li
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Colville Brown
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Stephen J Kanes
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
| | - Robert Lasser
- Sage Therapeutics, Inc., Cambridge, MA, United States of America
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16
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Ogasawara M, Takeshima M, Kosaka S, Imanishi A, Itoh Y, Fujiwara D, Yoshizawa K, Ozaki N, Nakagome K, Mishima K. Exploratory Validation of Sleep-Tracking Devices in Patients with Psychiatric Disorders. Nat Sci Sleep 2023; 15:301-312. [PMID: 37123093 PMCID: PMC10143764 DOI: 10.2147/nss.s400944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose Sleep-tracking devices have performed well in recent studies that evaluated their use in healthy adults by comparing them with the gold standard sleep assessment technique, polysomnography (PSG). These devices have not been validated for use in patients with psychiatric disorders. Therefore, we tested the performance of three sleep-tracking devices against PSG in patients with psychiatric disorders. Patients and methods In total, 52 patients (32 women; 48.1 ± 17.2 years, mean ± SD; 18 patients diagnosed with schizophrenia, 19 with depressive disorder, 3 with bipolar disorder, and 12 with sleep disorder cases) were tested in a sleep laboratory with PSG, along with portable electroencephalography (EEG) device (Sleepgraph), actigraphy (MTN-220/221) and consumer sleep-tracking device (Fitbit Sense). Results Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Sleepgraph (0.95, 0.76), Fitbit Sense (0.95, 0.45) and MTN-220/221 (0.93, 0.40). Portable EEG (Sleepgraph) had the best sleep stage-tracking performance. Sleep-wake summary metrics demonstrated lower performance on poor sleep (ice, shorter total sleep time, lower sleep efficiency, longer sleep latency, longer wake after sleep onset). Conclusion Devices demonstrated similar sleep-wake detecting performance as compared with previous studies that evaluated sleep in healthy adults. Consumer sleep device may exhibit poor sleep stage-tracking performance in patients with psychiatric disorders due to factors that affect the sleep determination algorithm, such as changes in autonomic nervous system activity. However, Sleepgraph, a portable EEG device, demonstrated higher performance in mental disorders than the Fitbit Sense and actigraphy.
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Affiliation(s)
- Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shumpei Kosaka
- Department of Psychiatry, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan
| | - Aya Imanishi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Dai Fujiwara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Norio Ozaki
- Department of Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
- Correspondence: Kazuo Mishima, Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan, Tel +81-18-884-6122, Fax +81-18-884-6445, Email
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Matsuura Y, Hongo S, Taniguchi H, Yasuno F, Sakai T. Effect of Acupuncture on Physical Symptoms and Quality of Life in Treatment-Resistant Major Depressive Disorder and Bipolar Disorder: a Single-Arm Longitudinal Study. J Acupunct Meridian Stud 2022; 15:336-346. [DOI: 10.51507/j.jams.2022.15.6.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/22/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yuto Matsuura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Seiji Hongo
- Himorogi Psychiatric Institute, Tokyo, Japan
| | - Hiroshi Taniguchi
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Fumiko Yasuno
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Tomomi Sakai
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
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Updates on the Role of Probiotics against Different Health Issues: Focus on Lactobacillus. Int J Mol Sci 2022; 24:ijms24010142. [PMID: 36613586 PMCID: PMC9820606 DOI: 10.3390/ijms24010142] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This review article is built on the beneficial effects of Lactobacillus against different diseases, and a special focus has been made on its effects against neurological disorders, such as depression, multiple sclerosis, Alzheimer's, and Parkinson's disease. Probiotics are live microbes, which are found in fermented foods, beverages, and cultured milk and, when administered in an adequate dose, confer health benefits to the host. They are known as "health-friendly bacteria", normally residing in the human gut and involved in maintaining homeostatic conditions. Imbalance in gut microbiota results in the pathophysiology of several diseases entailing the GIT tract, skin, immune system, inflammation, and gut-brain axis. Recently, the use of probiotics has gained tremendous interest, because of their profound effects on the management of these disease conditions. Recent findings suggest that probiotics enrichment in different human and mouse disease models showed promising beneficial effects and results in the amelioration of disease symptoms. Thus, this review focuses on the current probiotics-based products, different disease models, variable markers measured during trials, and evidence obtained from past studies on the use of probiotics in the prevention and treatment of different diseases, covering the skin to the central nervous system diseases.
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Whiston A, Igou ER, Fortune DG, Analog Devices Team, Semkovska M. Examining Stress and Residual Symptoms in Remitted and Partially Remitted Depression Using a Wearable Electrodermal Activity Device: A Pilot Study. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 11:96-106. [PMID: 36644642 PMCID: PMC9833495 DOI: 10.1109/jtehm.2022.3228483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/06/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Consistent evidence suggests residual symptoms and stress are the most reliable predictors of relapse in remitted depression. Prevailing methodologies often do not enable continuous real-time sampling of stress. Thus, little is known about day-to-day interactions between residual symptoms and stress in remitted depression. In preparation for a full-scale trial, this study aimed to pilot a wrist-worn wearable electrodermal activity monitor: ADI (Analog Devices, Inc.) Study Watch for assessing interactions between physiological stress and residual depressive symptoms following depression remission. 13 individuals remitted from major depression completed baseline, daily diary, and post-daily diary assessments. Self-reported stress and residual symptoms were measured at baseline and post-daily diary. Diary assessments required participants to wear ADI's Study Watch during waking hours and complete self-report questionnaires every evening over one week. Sleep problems, fatigue, energy loss, and agitation were the most frequently reported residual symptoms. Average skin conductance responses (SCRs) were 16.09 per-hour, with an average of 11.30 hours of wear time per-day. Increased residual symptoms were associated with enhanced self-reported stress on the same day. Increased SCRs on one day predicted increased residual symptoms on the next day. This study showed a wearable electrodermal activity device can be recommended for examining stress as a predictor of remitted depression. This study also provides preliminary work on relationships between residual symptoms and stress in remitted depression. Importantly, significant findings from the small sample of this pilot are preliminary with an aim to follow up with a 3-week full-scale study to draw conclusions about psychological processes explored. Clinical and Translational Impact Statemen-ADI's wearable electrodermal activity device enables a continuous measure of physiological stress for identifying its interactions with residual depressive symptoms following remission. This novel procedure is promising for future studies.
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Affiliation(s)
- Aoife Whiston
- Department of PsychologyUniversity of LimerickLimerickV94 T9PXIreland
| | - Eric R. Igou
- Department of PsychologyUniversity of LimerickLimerickV94 T9PXIreland
| | - Dónal G. Fortune
- Department of PsychologyUniversity of LimerickLimerickV94 T9PXIreland
| | | | - Maria Semkovska
- Department of PsychologyUniversity of Southern Denmark5230OdenseDenmark
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20
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Peng P, Liang M, Wang Q, Lu L, Wu Q, Chen Q. Night shifts, insomnia, anxiety, and depression among Chinese nurses during the COVID-19 pandemic remission period: A network approach. Front Public Health 2022; 10:1040298. [PMID: 36544790 PMCID: PMC9760836 DOI: 10.3389/fpubh.2022.1040298] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background The outbreak of the COVID-19 pandemic imposed a heavy workload on nurses with more frequent night shifts, which led to higher levels of insomnia, depression, and anxiety among nurses. The study aimed to describe the symptom-symptom interaction of depression, anxiety, and insomnia among nurses and to evaluate the impact of night shifts on mental distress via a network model. Methods We recruited 4,188 nurses from six hospitals in December 2020. We used the Insomnia Severity Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7 to assess insomnia, depression, and anxiety, respectively. We used the gaussian graphical model to estimate the network. Index expected influence and bridge expected influence was adapted to identify the central and bridge symptoms within the network. We assessed the impact of night shifts on mental distress and compared the network structure based on COVID-19 frontline experience. Results The prevalence of depression, anxiety, and insomnia was 59, 46, and 55%, respectively. Nurses with night shifts were at a higher risk for the three mental disorders. "Sleep maintenance" was the central symptom. "Fatigue," "Motor," "Restlessness," and "Feeling afraid" were bridge symptoms. Night shifts were strongly associated with sleep onset trouble. COVID-19 frontline experience did not affect the network structure. Conclusion "Sleep maintenance," "Fatigue," "Motor," and "Restlessness" were important in maintaining the symptom network of anxiety, depression, and insomnia in nurses. Further interventions should prioritize these symptoms.
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Affiliation(s)
- Pu Peng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mining Liang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qian Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lulu Lu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Qiuxia Wu
| | - Qiongni Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,Qiongni Chen
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Tsujii T, Sakurai H, Takeuchi H, Suzuki T, Mimura M, Uchida H. Predictors of response to pharmacotherapy in children and adolescents with psychiatric disorders: A combined post hoc analysis of four clinical trial data. Neuropsychopharmacol Rep 2022; 42:516-520. [PMID: 36330567 PMCID: PMC9773749 DOI: 10.1002/npr2.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The prediction of response to pharmacotherapy has not been sufficiently explored in children and adolescents with psychiatric disorders, which was addressed in this study. METHODS Data from four double-blind, placebo-controlled studies (sertraline and fluvoxamine for anxiety disorders, risperidone for autistic disorder, and fluoxetine for major depressive disorder) in children and adolescents funded by the National Institute of Mental Health were used. The response was defined as a score of 1 or 2 on the Clinical Global Impression-Global Improvement (CGI-I) at the endpoint. Logistic regression analysis was performed to evaluate associations between response status and the following variables: sex, diagnosis, treatment allocation, and CGI-Severity of Illness (CGI-S) score at baseline. Moreover, the presence of early improvement (a score of ≤3 in the CGI-I) at Week 1 was added to the independent variables in an additional binary logistic regression analysis, using the data from two studies. RESULTS A total of 599 patients were included in the analysis. In the binary logistic regression analysis, active drug use (odds ratio [OR] = 8.64, P < 0.001) and female sex (OR = 1.89, P = 0.002) were significantly associated with treatment response. In the second binary logistic regression, the presence of early improvement in the CGI-I (OR = 3.47, P = 0.009), as well as active drug use (OR = 15.05, P < 0.001) and female sex (OR = 2.87, P = 0.016), were associated with subsequent responses. CONCLUSION Allocation to active drugs, female sex, and early improvement may predict treatment response to pharmacotherapy among children and adolescents with psychiatric disorders.
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Affiliation(s)
- Takashi Tsujii
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan,Department of PsychiatryAsaka HospitalFukushimaJapan
| | - Hitoshi Sakurai
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Hiroyoshi Takeuchi
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Takefumi Suzuki
- Department of NeuropsychiatryUniversity of Yamanashi Faculty of MedicineYamanashiJapan
| | - Masaru Mimura
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Hiroyuki Uchida
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan,Geriatric Mental Health Program, Centre for Addiction and Mental HealthTorontoCanada
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22
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Peng P, Chen Q, Liang M, Liu Y, Chen S, Wang Y, Yang Q, Wang X, Li M, Wang Y, Hao Y, He L, Wang Q, Zhang J, Ma Y, He H, Zhou Y, Li Z, Xu H, Long J, Qi C, Tang YY, Liao Y, Tang J, Wu Q, Liu T. A network analysis of anxiety and depression symptoms among Chinese nurses in the late stage of the COVID-19 pandemic. Front Public Health 2022; 10:996386. [PMID: 36408014 PMCID: PMC9667894 DOI: 10.3389/fpubh.2022.996386] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/10/2022] [Indexed: 01/26/2023] Open
Abstract
Background Nurses are at high risk for depression and anxiety symptoms after the outbreak of the COVID-19 pandemic. We aimed to assess the network structure of anxiety and depression symptoms among Chinese nurses in the late stage of this pandemic. Method A total of 6,183 nurses were recruited across China from Oct 2020 to Apr 2021 through snowball sampling. We used Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder scale-7 (GAD-7) to assess depression and anxiety, respectively. We used the Ising model to estimate the network. The index "expected influence" and "bridge expected influence" were applied to determine the central symptoms and bridge symptoms of the anxiety-depression network. We tested the stability and accuracy of the network via the case-dropping procedure and non-parametric bootstrapping procedure. Result The network had excellent stability and accuracy. Central symptoms included "restlessness", "trouble relaxing", "sad mood", and "uncontrollable worry". "Restlessness", "nervous", and "suicidal thoughts" served as bridge symptoms. Conclusion Restlessness emerged as the strongest central and bridge symptom in the anxiety-depression network of nurses. Intervention on depression and anxiety symptoms in nurses should prioritize this symptom.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiongni Chen
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mining Liang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yueheng Liu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shubao Chen
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yunfei Wang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qian Yang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xin Wang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Manyun Li
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yingying Wang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li He
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Wang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Junhong Zhang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuejiao Ma
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haoyu He
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,Department of Psychology, College of Education, Hunan First Normol University, Changsha, China
| | - Yanan Zhou
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital, Changsha, China
| | - Zejun Li
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huixue Xu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiang Long
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Qi
- Department of Psychiatry, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiuxia Wu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,Qiuxia Wu
| | - Tieqiao Liu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China,*Correspondence: Tieqiao Liu
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23
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Lambrichts S, Vansteelandt K, Hebbrecht K, Wagenmakers MJ, Oudega ML, Obbels J, van Exel E, Dols A, Bouckaert F, Schrijvers D, Verwijk E, Sienaert P. Which residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression? J Psychiatr Res 2022; 154:111-116. [PMID: 35933854 DOI: 10.1016/j.jpsychires.2022.07.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/23/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
The risk of relapse following successful acute-phase treatment of late-life depression (LLD), including electroconvulsive therapy (ECT), is substantial. In order to improve reliable prediction of individuals' risk of relapse, we assessed the association between individual residual symptoms following a successful acute course of ECT for LLD and relapse at six-month follow-up. This prospective cohort study was part of the MODECT study, which included 110 patients aged 55 years and older with major depressive disorder. Participants who showed response to the index ECT course were monitored for relapse for six months. We used multivariable stepwise logistic regression models to assess the association between the scores on the 10 individual Montgomery-Åsberg Depression Rating Scale (MADRS) items at the end of the acute ECT course and relapse at six-month follow-up. Of the 80 responders with available six-month follow-up data (58.75% of which had psychotic features at baseline), 36.25% had relapsed. Higher scores on the MADRS items 'reduced sleep' (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.11-3.69, p = 0.0214) and 'lassitude' (OR = 1.62, 95% CI = 1.00-2.62, p = 0.0497) at the end of the acute ECT course were significantly associated with increased risk of relapse at six-month follow-up. In conclusion, some residual depressive symptoms, including sleep disturbance and lassitude, may help better identify patients vulnerable to relapse following a successful acute course of ECT for LLD. If these findings can be replicated, studies assessing interventions that target specific residual symptoms may further reduce post-ECT depressive relapse rates.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Margot J Wagenmakers
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Mardien L Oudega
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Eric van Exel
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Annemiek Dols
- GGZ in Geest Specialized Mental Health Care, Old Age Psychiatry, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Filip Bouckaert
- KU Leuven, University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Esmée Verwijk
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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24
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Insomnia, sleep loss, and circadian sleep disturbances in mood disorders: a pathway toward neurodegeneration and neuroprogression? A theoretical review. CNS Spectr 2022; 27:298-308. [PMID: 33427150 DOI: 10.1017/s1092852921000018] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The present paper aims at reviewing and commenting on the relationships between sleep and circadian phasing alterations and neurodegenerative/neuroprogressive processes in mood disorder. We carried out a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed, PsycINFO, and Embase electronic databases for literature related to mood disorders, sleep disturbances, and neurodegenerative/neuroprogressive processes in relation to (1) neuroinflammation, (2) activation of the stress system, (3) oxidative stress, (4) accumulation of neurotoxic proteins, and (5) neuroprotection deficit. Seventy articles were collectively selected and analyzed. Experimental and clinical studies revealed that insomnia, conditions of sleep loss, and altered circadian sleep may favor neurodegeneration and neuroprogression in mood disorders. These sleep disturbances may induce a state of chronic inflammation by enhancing neuroinflammation, both directly and indirectly, via microglia and astrocytes activation. They may act as neurobiological stressors that by over-activating the stress system may negatively influence neural plasticity causing neuronal damage. In addition, sleep disturbances may favor the accumulation of neurotoxic proteins, favor oxidative stress, and a deficit in neuroprotection hence contributing to neurodegeneration and neuroprogression. Targeting sleep disturbances in the clinical practice may hold a neuroprotective value for mood disorders.
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25
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Zhang ZQ, Yang MH, Guo ZP, Liao D, Sörös P, Li M, Walter M, Wang L, Liu CH. Increased prefrontal cortex connectivity associated with depression vulnerability and relapse. J Affect Disord 2022; 304:133-141. [PMID: 35219743 DOI: 10.1016/j.jad.2022.02.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/28/2022] [Accepted: 02/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent mood disorder, characterized by depressed mood, reduced capabilities to concentrate, impaired cognition, as well as a high risk of relapse. Unaffected siblings who have high risks for MDD development and yet without clinical symptoms may be helpful for understanding the neural mechanisms of MDD traits. METHODS We investigated both regional fluctuation and inter-regional synchronization in 31 fully remitted MDD patients, 29 unaffected siblings and 43 age, gender, and educational level matched helathy controls (HCs) using resting-state functional magnetic resonance imaging (rs-fMRI). The 17-item HAMD and neurocognitive scales were performed. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) strength were investigated. RESULTS Compared with healthy control group, patients with remitted MDD and unaffected siblings showed increased fALFF in the left dorsomedial prefrontal cortex (dmPFC) and increased FC between the left dmPFC and the right ventromedial prefrontal cortex (vmPFC). In addition, a negative correlation was observed between the fALFF value in the left dmPFC and the speed of Trail Making Test in the remitted MDD patients. Higher vmPFC-dmPFC FC was positively correlated with Wisconsin Card Sorting Test (WCST) total correct, and negatively correlated with WCST random errors. CONCLUSIONS In the absence of clinical symptoms, individuals with remitted MDD and unaffected siblings showed increased fALFF in left dmPFC as well as the vmPFC-dmPFC connectivity. These results suggest a specific trait abnormality in the default mode network associated with vulnerability to MDD, which may have implications for developing effective therapies using this network as a target.
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Affiliation(s)
- Zhu-Qing Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Chinese Medicine, Beijing 100010, China
| | - Ming-Hao Yang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Chinese Medicine, Beijing 100010, China
| | - Zhi-Peng Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Chinese Medicine, Beijing 100010, China
| | - Dan Liao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Chinese Medicine, Beijing 100010, China
| | - Peter Sörös
- Research Center Neurosensory Science, Carl von Ossietzky University of Oldenburg, Oldenburg 26129, Germany
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg 39120, Germany; Department of Psychiatry and Psychotherapy, University Tuebingen, Tuebingen 72074, Germany; Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, 07743 Jena, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg 39120, Germany; Department of Psychiatry and Psychotherapy, University Tuebingen, Tuebingen 72074, Germany; Leibniz Institute for Neurobiology, Magdeburg 39118, Germany; Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, 07743 Jena, Germany
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, USA.
| | - Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Chinese Medicine, Beijing 100010, China.
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26
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Assessment of Suvorexant and Eszopiclone as Alternatives to Benzodiazepines for Treating Insomnia in Patients With Major Depressive Disorder. Clin Neuropharmacol 2022; 45:52-60. [DOI: 10.1097/wnf.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Sakurai H, Uribe S, Cirillo P, Fuertes-Saiz A, Camprodon JA, Barbour T. Residual symptoms after achieving remission with repetitive transcranial magnetic stimulation in depression. J Affect Disord 2022; 301:154-161. [PMID: 34998805 DOI: 10.1016/j.jad.2021.12.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Sofia Uribe
- Department of Psychiatry, Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, 149 13th Street, 2nd floor, Boston, MA, United States
| | - Patricia Cirillo
- Department of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alejandro Fuertes-Saiz
- Transcranial Magnetic Stimulation Unit, Hospital La Salud, Valencia, Spain; Department of Medicine and Surgery, TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Joan A Camprodon
- Department of Psychiatry, Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, 149 13th Street, 2nd floor, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, MA, United States
| | - Tracy Barbour
- Department of Psychiatry, Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, 149 13th Street, 2nd floor, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, MA, United States.
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28
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Whiston A, Lennon A, Brown C, Looney C, Larkin E, O'Sullivan L, Sik N, Semkovska M. A Systematic Review and Individual Patient Data Network Analysis of the Residual Symptom Structure Following Cognitive-Behavioral Therapy and Escitalopram, Mirtazapine and Venlafaxine for Depression. Front Psychiatry 2022; 13:746678. [PMID: 35178002 PMCID: PMC8843824 DOI: 10.3389/fpsyt.2022.746678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Consistent evidence suggests residual depressive symptomology are the strongest predictors of depression relapse following cognitive-behavioral therapy (CBT) and antidepressant medications (ADM's). Psychometric network models help detecting and understanding central symptoms that remain post-treatment, along with their complex co-occurrences. However, individual psychometric network studies show inconsistent findings. This systematic review and IPD network analysis aimed to estimate and compare the symptom network structures of residual depressive symptoms following CBT, ADM's, and their combination. METHODS PsycINFO, PsycArticles, and PubMed were systematically searched through October 2020 for studies that have assessed individuals with major depression at post-treatment receiving either CBT and/or ADM's (venlafaxine, escitalopram, mirtazapine). IPD was requested from eligible samples to estimate and compare residual symptom psychometric network models post-CBT and post-ADM's. RESULTS In total, 25 from 663 eligible samples, including 1,389 patients qualified for the IPD. Depressed mood and anhedonia were consistently central residual symptoms post-CBT and post-ADM's. For CBT, fatigue-related and anxiety symptoms were also central post-treatment. A significant difference in network structure across treatments (CBT vs. ADM) was observed for samples measuring depression severity using the MADRS. Specifically, stronger symptom occurrences were present amongst lassitude-suicide post-CBT (vs. ADM's) and amongst lassitude-inability to feel post-ADM's (vs. CBT). No significant difference in global strength was observed across treatments. CONCLUSIONS Core major depression symptoms remain central across treatments, strategies to target these symptoms should be considered. Anxiety and fatigue related complaints also remain central post-CBT. Efforts must be made amongst researchers, institutions, and journals to permit sharing of IPD.Systematic Review Registration: A protocol was prospectively registered on PROSPERO (CRD42020141663; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=141663).
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Amy Lennon
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Catherine Brown
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Chloe Looney
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Eve Larkin
- Department of Psychology, University of Limerick, Limerick, Ireland
| | | | - Nurcan Sik
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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29
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Rogers BG, Bainter SA, Smith-Alvarez R, Wohlgemuth WK, Antoni MH, Rodriguez AE, Safren SA. Insomnia, Health, and Health-related Quality of Life in an Urban Clinic Sample of People Living with HIV/AIDS. Behav Sleep Med 2021; 19:516-532. [PMID: 32781842 PMCID: PMC7878571 DOI: 10.1080/15402002.2020.1803871] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE/BACKGROUND Insomnia is a prevalent and interfering comorbidity of HIV infection. Nearly 70% of people living with HIV/AIDS (PLWHA) experience symptoms of insomnia and associated distress. The current study examined the mechanisms of insomnia in HIV health status and health-related quality of life and explored behavioral pathways to explain relationships. PARTICIPANTS Participants (N = 103) were active patients in an HIV clinic located within a nonprofit, tertiary care hospital in a large, urban city in the Southeast United States. METHODS Participants completed a clinical sleep interview and self-report assessments for adherence to antiretroviral medication, depression (PHQ-9), quality of life (ACTG-QOL), and relevant covariates. Viral load and CD4 were obtained via medical chart review. RESULTS Insomnia affected 67% of the clinic sample. Insomnia symptoms were directly associated with poorer health-related quality of life (p<.001). Greater insomnia symptoms were also significantly associated with greater depressive symptoms [b =.495, S.E. =.061], poorer medication adherence [b = -.912, S.E. =.292], and worse health status measured by absolute CD4 count [b = -.011, S.E. =.005]. CONCLUSIONS In this sample of PLWHA, insomnia was associated with poorer health-related quality of life and worse health status. Future research and practice should consider insomnia treatment for this population, as it could improve overall health and well-being.
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Affiliation(s)
- Brooke G. Rogers
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Sierra A. Bainter
- Department of Psychology, University of Miami, Coral Gables, Florida
| | | | - William K. Wohlgemuth
- Department of Psychology, University of Miami, Coral Gables, Florida
- Miami Veterans Affairs Health Care System
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Alan E. Rodriguez
- Internal Medicine, Infectious Disease, University of Miami, Coral Gables, Florida
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida
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30
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Flint AJ, Bingham KS, Neufeld NH, Alexopoulos GS, Mulsant BH, Rothschild AJ, Whyte EM, Voineskos AN, Marino P, Meyers BS. Association between psychomotor disturbance and treatment outcome in psychotic depression: a STOP-PD II report. Psychol Med 2021; 52:1-7. [PMID: 33766150 DOI: 10.1017/s0033291721000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about the relationship between psychomotor disturbance (PMD) and treatment outcome of psychotic depression. This study examined the association between PMD and subsequent remission and relapse of treated psychotic depression. METHODS Two hundred and sixty-nine men and women aged 18-85 years with an episode of psychotic depression were treated with open-label sertraline plus olanzapine for up to 12 weeks. Participants who remained in remission or near-remission following an 8-week stabilization phase were eligible to participate in a 36-week randomized controlled trial (RCT) that compared the efficacy and tolerability of sertraline plus olanzapine (n = 64) with sertraline plus placebo (n = 62). PMD was measured with the psychiatrist-rated sign-based CORE at acute phase baseline and at RCT baseline. Spearman's correlations and logistic regression analyses were used to analyze the association between CORE total score at acute phase baseline and remission/near-remission and CORE total score at RCT baseline and relapse. RESULTS Higher CORE total score at acute phase baseline was associated with lower frequency of remission/near-remission. Higher CORE total score at RCT baseline was associated with higher frequency of relapse, in the RCT sample as a whole, as well as in each of the two randomized groups. CONCLUSIONS PMD is associated with poorer outcome of psychotic depression treated with sertraline plus olanzapine. Future research needs to examine the neurobiology of PMD in psychotic depression in relation to treatment outcome.
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Affiliation(s)
- Alastair J Flint
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Kathleen S Bingham
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicholas H Neufeld
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Benoit H Mulsant
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Aristotle N Voineskos
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Barnett S Meyers
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
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31
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Inada K, Enomoto M, Yamato K, Marumoto T, Takeshima M, Mishima K. Effect of residual insomnia and use of hypnotics on relapse of depression: a retrospective cohort study using a health insurance claims database. J Affect Disord 2021; 281:539-546. [PMID: 33401142 DOI: 10.1016/j.jad.2020.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Residual insomnia is associated with a risk of depression recurrence. METHODS In this retrospective, longitudinal cohort study, the recurrence pattern of depression in patients with or without residual insomnia was assessed using a health insurance claims database. Patients who were diagnosed with major depressive disorder and prescribed antidepressants, between January 2006 and June 2017 in Japan, were enrolled in the study. Residual insomnia was defined by a prescription of hypnotics, and recurrence of depression by prescription of antidepressants. Main outcomes included time to recurrence and the 1-year recurrence rate. Factors associated with recurrence of depression were assessed by multivariate analyses. The effect of residual insomnia on the frequency of recurrence was assessed by Chi-square test. RESULTS Of the 30,381 patients analyzed, there were 4,166 and 26,215 patients with or without residual insomnia, respectively. Time to recurrence in patients with residual insomnia was significantly shorter compared with those without residual insomnia (p <0.001), with a 1-year recurrence rate (95% CI) of 43.4% (41.9-45.0) and 7.4% (7.1-7.7), respectively. The frequency of recurrence was significantly higher in patients with residual insomnia than in those without (p <0.0001). A higher risk of depression recurrence (odds ratio 9.98, 95% CI 9.22-10.81) was found for residual insomnia compared with other significant factors. LIMITATIONS The diagnosis stated in the receipt data may not accurately reflect the patient's condition, and medication adherence was unknown but assumed. CONCLUSIONS Residual insomnia is a significant risk factor for depression recurrence in Japanese patients.
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Affiliation(s)
- Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Tatsuro Marumoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
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Yamato K, Inada K, Enomoto M, Marumoto T, Takeshima M, Mishima K. Patterns of hypnotic prescribing for residual insomnia and recurrence of major depressive disorder: a retrospective cohort study using a Japanese health insurance claims database. BMC Psychiatry 2021; 21:40. [PMID: 33441086 PMCID: PMC7807418 DOI: 10.1186/s12888-021-03046-z] [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: 10/30/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent in Japan and frequently accompanied by insomnia that may persist even with MDD remission. Hypnotics are used for the pharmacological treatment of insomnia, but their influence on MDD recurrence or residual insomnia following MDD remission is unclear. This retrospective, longitudinal, cohort study utilized a large Japanese health insurance claims database to investigate patterns of hypnotic prescriptions among patients with MDD, and the influence of hypnotic prescription pattern on MDD recurrence. METHODS Eligible patients (20-56 years) were those registered in the Japan Medical Data Center database between 1 January 2005 and 31 December 2018, and prescribed antidepressant and hypnotic therapy after being diagnosed with MDD. Patients who had ceased antidepressant therapy for > 180 days were followed for 1 year to evaluate depression recurrence, as assessed using Kaplan-Meier estimates. Logistic regression modelling was used to analyze the effect of hypnotic prescription pattern on MDD recurrence. RESULTS Of the 179,174 patients diagnosed with MDD who initiated antidepressant treatment between 1 January 2006 and 30 June 2017, complete prescription information was available for 2946 eligible patients who had been prescribed hypnotics. More patients were prescribed hypnotic monotherapy (70.8%) than combination therapy (29.2%). The most prescribed therapies were benzodiazepine monotherapy (26.2%), non-benzodiazepine monotherapy (28.9%), and combination therapy with two drugs (21.1%). Among patients prescribed multiple hypnotics, concomitant prescriptions for anxiolytics, antipsychotics, mood stabilizers and sedative antidepressants were more common. The 1-year recurrence rate for MDD was approximately 20%, irrespective of hypnotic mono- versus combination therapy or class of hypnotic therapy. Being a spouse (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.03-2.02) or other family member (OR, 1.46, 95% CI, 0.99-2.16) of the insured individual, or being prescribed a sedative antidepressant (OR, 1.50, 95% CI, 1.24-1.82) conferred higher odds of MDD recurrence within 1 year of completing antidepressant therapy. CONCLUSIONS Benzodiazepines are the most prescribed hypnotic among Japanese patients with MDD, though combination hypnotic therapy is routinely prescribed. Hypnotic prescription pattern does not appear to influence real-world MDD recurrence, though hypnotics should be appropriately prescribed given class differences in efficacy and safety.
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Affiliation(s)
- Kentaro Yamato
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ken Inada
- grid.410818.40000 0001 0720 6587Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Minori Enomoto
- grid.412788.00000 0001 0536 8427Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsuro Marumoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masahiro Takeshima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan. .,Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. .,International Institute for Integrative Sleep Medicine, Tsukuba, Japan.
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Wang XQ, Wang DQ, Bao YP, Liu JJ, Chen J, Wu SW, Luk HN, Yu L, Sun W, Yang Y, Wang XH, Lu L, Deng JH, Li SX. Preliminary Study on Changes of Sleep EEG Power and Plasma Melatonin in Male Patients With Major Depressive Disorder After 8 Weeks Treatment. Front Psychiatry 2021; 12:736318. [PMID: 34867527 PMCID: PMC8632954 DOI: 10.3389/fpsyt.2021.736318] [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: 07/05/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To clarify the effects of escitalopram on sleep EEG power in patients with Major depressive disorder (MDD). Method: Polysomnography (PSG) was detected overnight, and blood samples were collected at 4 h intervals over 24 h from 13 male healthy controls and 13 male MDD patients before and after treatment with escitalopram for 8 weeks. The outcome measures included plasma melatonin levels, sleep architecture, and the sleep EEG power ratio. Results: Compared with healthy controls, MDD patients presented abnormalities in the diurnal rhythm of melatonin secretion, including peak phase delayed 3 h and a decrease in plasma melatonin levels at night and an increase at daytime, accompanied by sleep disturbances, a decrease in low-frequency bands and an increase in high-frequency bands, and the dominant right-side brain activity. Several of these abnormalities (abnormalities in the diurnal rhythm of melatonin secretion, partial sleep architecture parameters) persisted for at least the 8-week testing period. Conclusions: Eight weeks of treatment with escitalopram significantly improved subjective sleep perception and depressive symptoms of patients with MDD, and partially improved objective sleep parameters, while the improvement of circadian rhythm of melatonin was limited.
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Affiliation(s)
- Xue-Qin Wang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - De-Quan Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Jia Liu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Jie Chen
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Shao-Wei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Hsuan-Nu Luk
- Peking University Health Science Center, Beijing, China
| | - Ling Yu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Wei Sun
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Yong Yang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | | | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jia-Hui Deng
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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Abstract
Pregnancy, a sensitive time when two bodies are changing and developing simultaneously, demands careful consideration in assessing and treating mental health conditions. Add to that the restrictions on researching such a vulnerable population, psychiatric nurses face a challenge in providing evidence-based care. The current article focuses on the epidemiology of postpartum depression and long-term consequences, neurobiology of postpartum depression that guides medication selection, and treatment options for supporting postpartum women and their families. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 9-14.].
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Rush AJ, Thase ME. Improving Depression Outcome by Patient-Centered Medical Management. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:244-254. [PMID: 33343242 DOI: 10.1176/appi.focus.18207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 12/01/2022]
Abstract
(Reprinted with permission from The American Journal of Psychiatry 2018; 175:1187-1198).
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Affiliation(s)
- A John Rush
- Duke-National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center-Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia
| | - Michael E Thase
- Duke-National University of Singapore Graduate Medical School, Singapore; the Department of Psychiatry, Duke University Medical School, Durham, N.C.; the Department of Psychiatry, Texas Tech Health Sciences Center-Permian Basin, Midland-Odessa; the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and the Corporal Michael J. Crescenz VA Medical Center, Philadelphia
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Walther S, Alexaki D, Schoretsanitis G, Weiss F, Vladimirova I, Stegmayer K, Strik W, Schäppi L. Inhibitory Repetitive Transcranial Magnetic Stimulation to Treat Psychomotor Slowing: A Transdiagnostic, Mechanism-Based Randomized Double-Blind Controlled Trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Psychomotor slowing is frequently distressing patients with depression and schizophrenia. Increased neural activity within premotor cortices is linked to psychomotor slowing. This transdiagnostic study tested whether add-on inhibitory repetitive transcranial magnetic stimulation (rTMS) of the supplementary motor area (SMA) may alleviate psychomotor slowing. Forty-five patients with severe psychomotor slowing (26 psychosis, 19 major depression) were randomized in this transdiagnostic, double-blind, parallel-group, sham-controlled trial of 15 daily sessions of add-on rTMS over 3 weeks. Treatment arms included inhibitory 1 Hz stimulation of the SMA, facilitatory intermittent theta burst stimulation (iTBS) of the SMA, facilitatory 15 Hz stimulation of the left dorsolateral prefrontal cortex (DLPFC), and sham stimulation of the occipital cortex. The primary outcome was response (>30% reduction from baseline) according to the Salpêtrière Retardation Rating Scale (SRRS). Secondary outcomes were course of SRRS and further symptom rating scales. Last-observation carried forward method was applied to all subjects with baseline data. Response rates differed between protocols: 82% with inhibitory 1 Hz rTMS of the SMA, 0% with facilitatory iTBS of the SMA, 30% with sham, and 33% with 15 Hz DLPFC rTMS (χ 2 = 16.6, P < .001). Dropouts were similarly distributed across protocols. Response rates were similar in the completer analysis. This transdiagnostic trial of rTMS demonstrates that inhibitory SMA stimulation may ameliorate psychomotor slowing in severely ill patients. It further provides proof-of-concept that motor inhibition is linked to increased neural activity in the SMA because the inhibitory protocol performed best in reducing symptoms.
Trial registration: NCT03275766 (www.clinicaltrials.gov).
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Georgios Schoretsanitis
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Florian Weiss
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Irena Vladimirova
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Lea Schäppi
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Predicting relapse with residual symptoms in schizophrenia: A secondary analysis of the PROACTIVE trial. Schizophr Res 2020; 215:173-180. [PMID: 31672387 DOI: 10.1016/j.schres.2019.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little attention has been paid to the contribution of individual residual symptom to predict relapse in patients with schizophrenia receiving oral or long-acting injectable (LAI) antipsychotics. METHOD We used the data from the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study, in which 305 outpatients with schizophrenia were randomly allocated to either biweekly LAI-risperidone (LAI-R) or daily oral second-generation antipsychotics (SGA) and assessed for up to 30 months. Baseline individual symptoms that could predict subsequent relapse were identified, using a Cox proportional hazards model. Moreover, among those who relapsed during the study (n = 73), individual symptoms were compared between baseline and biweekly ratings 8 to 2 weeks before relapse, using the linear mixed model. RESULTS A greater score in grandiosity at baseline was significantly associated with subsequent relapse (adjusted HR = 1.24, p = 0.006). When the two treatment groups were separately analyzed, more severe grandiosity (adjusted HR = 1.43, p = 0.003) and less severe hallucinatory behavior (adjusted HR = 0.70, p = 0.013) at baseline were significantly associated with relapse in the oral SGA group, but none was identified in the LAI-R group. Emotional withdrawal was significantly worse 8 and 2 weeks before relapse compared to the baseline (p = 0.032 and p = 0.043, respectively). DISCUSSION More severe grandiosity and less hallucination may have led to more frequent relapses in patients with schizophrenia receiving oral antipsychotics, which was not a case in those receiving LAI-R. The exploratory analysis indicates an increase in emotional withdrawal before relapse may be a useful marker for earlier interventions to possibly avert relapse.
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Slofstra C, Booij SH, Rogier Hoenders HJ, Castelein S. Redefining Therapeutic Outcomes of Depression Treatment. J Pers Oriented Res 2019; 5:1-8. [PMID: 33569141 PMCID: PMC7842646 DOI: 10.17505/jpor.2019.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery.
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Affiliation(s)
- Christien Slofstra
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands
| | - Sanne H Booij
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, CC72, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands
| | - Stynke Castelein
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands.,Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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Kumagai N, Tajika A, Hasegawa A, Kawanishi N, Horikoshi M, Shimodera S, Kurata K, Chino B, Furukawa TA. Predicting recurrence of depression using lifelog data: an explanatory feasibility study with a panel VAR approach. BMC Psychiatry 2019; 19:391. [PMID: 31829206 PMCID: PMC6907185 DOI: 10.1186/s12888-019-2382-2] [Citation(s) in RCA: 10] [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] [Received: 04/22/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although depression has a high rate of recurrence, no prior studies have established a method that could identify the warning signs of its recurrence. METHODS We collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. We assessed depression and its recurrence using both the Kessler Psychological Distress Scale (K6) and the Patient Health Questionnaire-9. RESULTS A panel vector autoregressive analysis indicated that long sleep time was a important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. CONCLUSIONS The panel vector autoregressive approach can identify the warning signs of depression recurrence; however, the convenient sampling of the present cohort may limit the scope towards drawing a generalised conclusion.
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Affiliation(s)
- Narimasa Kumagai
- grid.443473.3Department of Economics, Seinan Gakuin University, 6-2-92, Nishijin, Sawara-ku, Fukuoka, 814-8511 Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akio Hasegawa
- 0000 0001 2291 1583grid.418163.9Advanced Telecommunications Research Institute International, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, 619-0288 Japan
| | - Nao Kawanishi
- Sonas Inc., 6F, Grace Imas Building, 5-24-2, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Masaru Horikoshi
- 0000 0004 1763 8916grid.419280.6National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553 Japan
| | - Shinji Shimodera
- Ginza Shimodera Clinic, 8B-6-9-6 Ginza Chuo Ward, Tokyo, 104-0061 Japan ,0000 0004 0372 2033grid.258799.8Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Ken’ichi Kurata
- Kabe Mental Health Clinic, 4-6-2 Kabe, Asakita-ku, Hiroshima, 731-0221 Japan
| | - Bun Chino
- Ginza Taimei Clinic, 5-1-15 Ginza, Chuou-ku, Tokyo, 104-0061 Japan
| | - Toshi A. Furukawa
- 0000 0004 0372 2033grid.258799.8Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
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Tajika A, Furukawa TA, Inagaki M, Kato T, Mantani A, Kurata K, Ogawa Y, Takeshima N, Hayasaka Y, Noma H, Maruo K. Trajectory of criterion symptoms of major depression under newly started antidepressant treatment: sleep disturbances and anergia linger on while suicidal ideas and psychomotor symptoms disappear early. Acta Psychiatr Scand 2019; 140:532-540. [PMID: 31618446 DOI: 10.1111/acps.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In modern psychiatry, depression is diagnosed with the diagnostic criteria; however, the trajectory of each of the criterion symptoms is unknown. This study aims to examine this. METHODS We made repeated assessments of the nine diagnostic criterion symptoms with the Patient Health Questionnaire-9 (PHQ-9) among 2011 participants of a 25-week pragmatic randomised controlled trial of sertraline and/or mirtazapine for hitherto untreated major depressive episodes. The changes from baseline were estimated with the mixed-effects model with repeated measures. The time to disappearance of each symptom was modeled using the Kaplan-Meier survival analysis. RESULTS The total score on PHQ-9 was 18.5 (SD = 3.9, n = 2011) at baseline, which decreased to 15.3 (5.2, n = 2011) at week 1, to 11.5 (5.9, n = 1953) at week 3, to 7.8 (6.0, n = 1927) at week 9, and to 6.0 (5.9, n = 1910) at week 25. Suicidal ideas, psychomotor symptoms decreased rapidly, while anergia and sleep disturbance also decreased but only slowly. The survival analyses confirmed the primary analyses. CONCLUSIONS Upon initiation of antidepressant treatment, patients with newly treated major depressive episodes can expect their suicidal ideas and psychomotor symptoms to disappear first but sleep disturbances and anergia to linger on.
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Affiliation(s)
- A Tajika
- Department of Neurosychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - M Inagaki
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - T Kato
- Aratama Kokorono Clinic, Nagoya, Japan
| | - A Mantani
- Mantani Mental Clinic, Hiroshima, Japan
| | - K Kurata
- Kabe Mental Health Clinic, Hiroshima, Japan
| | - Y Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - N Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Y Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - H Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Brupbacher G, Straus D, Porschke H, Zander-Schellenberg T, Gerber M, von Känel R, Schmidt-Trucksäss A. The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial. Trials 2019; 20:352. [PMID: 31196147 PMCID: PMC6567535 DOI: 10.1186/s13063-019-3415-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most important mental disorders. Insomnia is a symptom of cardinal importance in depression. It increases the risk to develop depression, negatively affects disease trajectory, is the most common symptom after remission, increases the risk of relapse, and is associated with higher suicide rates. Existing therapies for insomnia in depression have limitations. Further adjuvant therapies are therefore needed. Acute aerobic exercise has been shown to have beneficial effects on sleep in healthy individuals and patients with insomnia. We therefore hypothesize that a single session of aerobic exercise has a positive impact on sleep in patients with unipolar depression. This trial aims to investigate the effects of a single bout of aerobic exercise on the subsequent night's sleep in patients with depression. METHODS/DESIGN This is a two-arm parallel group, randomized, outcome assessor blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression (without a psychotic episode) are included. Exclusion criteria are regular use of hypnotic agents, opioids, and certain beta-blockers, as well as the presence of factors precluding exercise, history of epilepsy, restless legs syndrome, moderate obstructive sleep apnea, and a BMI > 40. The intervention is a single bout of aerobic exercise, performed for 30 min on a bicycle ergometer at 80% individual anaerobic threshold. The control group sits and reads for 30 min. The primary outcome is sleep efficiency measured by polysomnography. Secondary outcomes include further polysomnographic variables, subjective pre-sleep arousal, nocturnal cardiovascular autonomic modulation, subjective sleep quality, daytime sleepiness, and adverse events. According to the sample size calculation, a total of 92 patients will be randomized using minimization. DISCUSSION This trial will add new information to the body of knowledge concerning the treatment of insomnia in patients with depression. Thereby, the results will inform decision makers on the utility of acute aerobic exercise. TRIAL REGISTRATION Clinicaltrials.gov, NCT03673397 . Protocol version 1 registered on 17 September 2018.
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Brietzke E, Vazquez GH, Kang MJY, Soares CN. Pharmacological treatment for insomnia in patients with major depressive disorder. Expert Opin Pharmacother 2019; 20:1341-1349. [PMID: 31046480 DOI: 10.1080/14656566.2019.1614562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice. AREAS COVERED Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD. EXPERT OPINION Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.
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Affiliation(s)
- Elisa Brietzke
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada
| | - Gustavo H Vazquez
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada
| | - Melody J Y Kang
- c Center of Neuroscience Studies (CNS) , Queen's University , Kingston , ON , Canada
| | - Claudio N Soares
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada.,c Center of Neuroscience Studies (CNS) , Queen's University , Kingston , ON , Canada
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It is time to investigate integrative approaches to enhance treatment outcomes for depression? Med Hypotheses 2019; 126:82-94. [DOI: 10.1016/j.mehy.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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Palagini L, Bastien CH, Marazziti D, Ellis JG, Riemann D. The key role of insomnia and sleep loss in the dysregulation of multiple systems involved in mood disorders: A proposed model. J Sleep Res 2019; 28:e12841. [DOI: 10.1111/jsr.12841] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/20/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Laura Palagini
- Department of Clinical and Experimental Medicine Psychiatric Unit University of Pisa Pisa Italy
| | | | - Donatella Marazziti
- Department of Clinical and Experimental Medicine Psychiatric Unit University of Pisa Pisa Italy
| | - Jason G. Ellis
- Northumbria Sleep Research Laboratory Northumbria University Newcastle‐upon‐Tyne UK
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine Center for Mental Disorders University of Freiburg Freiburg Germany
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Murru A, Guiso G, Barbuti M, Anmella G, Verdolini N, Samalin L, Azorin JM, Angst JJ, Bowden CL, Mosolov S, Young AH, Popovic D, Valdes M, Perugi G, Vieta E, Pacchiarotti I. The implications of hypersomnia in the context of major depression: Results from a large, international, observational study. Eur Neuropsychopharmacol 2019; 29:471-481. [PMID: 30846287 DOI: 10.1016/j.euroneuro.2019.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 02/07/2023]
Abstract
According to the DSM-5, "reduction in the need for sleep" is the only sleep-related criteria for mixed features in depressive episodes. We aimed at studying the prevalence, clinical correlates and the role of hypersomnia in a sample of acutely depressed patients. Secondarily, we factors significantly increasing the odds of hypersomnia were studied. We conducted a post-hoc analysis of the BRIDGE-II-Mix study. Variables were compared between patients with hypersomnia (SLEEP+) and with insomnia (SLEEP-) with standard bivariate tests. A stepwise backward logistic regression model was performed with SLEEP+ as dependent variable. A total of 2514 subjects were dichotomized into SLEEP+ (n = 423, 16.8%) and SLEEP- (n = 2091, 83.2%). SLEEP+ had significant higher rates of obese BMI (p < 0.001), BD diagnosis (p = 0.027), severe BD (p < 0.001), lifetime suicide attempts (p < 0.001), lower age at first depression (p = 0.004) than SLEEP-. Also, SLEEP+ had significantly poorer response to antidepressants (AD) such as (hypo)manic switches, AD resistance, affective lability, or irritability (all 0<0.005). Moreover, SLEEP+ had significantly higher rates of mixed-state specifiers than SLEEP- (all 0 < 0.006). A significant contribution to hypersomnia in our regression model was driven by metabolic-related features, such as "current bulimia" (OR = 4.21) and "overweight/obese BMI (OR = 1.42)". Globally, hypersomnia is associated with poor outcome in acute depression. Hypersomnia is strongly associated with mixed features and bipolarity. Metabolic aspects could influence the expression of hypersomnia, worsening the overall clinical outcome. Along with commonly used screening tools, detection of hypersomnia has potential, costless discriminative validity in the differential diagnosis unipolar and bipolar depression.
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Affiliation(s)
- A Murru
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - G Guiso
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Clinica Psichiatrica, Dipartimento di Igiene e Sanità, Università di Cagliari, Italy
| | - M Barbuti
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - G Anmella
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - N Verdolini
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - L Samalin
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, Clermont-Ferrand, France; Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - J M Azorin
- Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - J Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - C L Bowden
- University of Texas Health Science Center, San Antonio, USA
| | - S Mosolov
- Moscow Research Institute of Psychiatry, Russia
| | - A H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D Popovic
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Psychiatry B, Sheba Medical Center, Israel
| | - M Valdes
- Department of Medicine, Sleep Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM; Barcelona, Catalonia, Spain
| | - G Perugi
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - E Vieta
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - I Pacchiarotti
- Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Effect of 25-methoxy hispidol A isolated from Poncirus trifoliate against bacteria-induced anxiety and depression by targeting neuroinflammation, oxidative stress and apoptosis in mice. Biomed Pharmacother 2019; 111:209-223. [DOI: 10.1016/j.biopha.2018.12.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022] Open
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Walther S, Bernard JA, Mittal VA, Shankman SA. The utility of an RDoC motor domain to understand psychomotor symptoms in depression. Psychol Med 2019; 49:212-216. [PMID: 30322416 DOI: 10.1017/s0033291718003033] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite the clinical impact of motor symptoms such as agitation or retardation on the course of depression, these symptoms are poorly understood. Novel developments in the field of instrumentation and mobile devices allow for dimensional and continuous recording of motor behavior in various settings, particularly outside the laboratory. Likewise, the use of novel assessments enables to combine multimodal neuroimaging with behavioral measures in order to investigate the neural correlates of motor dysfunction in depression. The research domain criteria (RDoC) framework will soon include a motor domain that will provide a framework for studying motor dysfunction in mood disorders. In addition, new studies within this framework will allow investigators to study motor symptoms across different stages of depression as well as other psychiatric diagnoses. Finally, the introduction of the RDoC motor domain will help test how motor symptoms integrate with the original five RDoC domains (negative valence, positive valence, cognitive, social processes, and arousal/regulation).
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Affiliation(s)
- S Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern,Bern,Switzerland
| | - J A Bernard
- Department of Psychological and Brain Sciences,Texas A&M Institute for Neuroscience, Texas A & M University,College Station, TX,USA
| | - V A Mittal
- Department of Psychology, Department of Psychiatry,Northwestern University,Evanston, IL,USA
| | - S A Shankman
- Department of Psychiatry,Northwestern University,Evanston, IL,USA
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Limandri BJ. Treatment-Resistant Depression: Identification and Treatment Strategies. J Psychosoc Nurs Ment Health Serv 2018; 56:11-15. [DOI: 10.3928/02793695-20180808-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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49
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The association of insomnia with future mental illness: is it just residual symptoms? Sleep Health 2018; 4:352-359. [DOI: 10.1016/j.sleh.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 01/19/2023]
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Targeting cytokines in reduction of depressive symptoms: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2018; 83:86-91. [PMID: 29309829 DOI: 10.1016/j.pnpbp.2018.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/12/2017] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
Heterogeneity in response to conventional antidepressants is a well-recognized limitation of evidence-based pharmacological treatments of major depressive disorder (MDD). Abnormal activation of inflammatory pathways is postulated as one likely mechanism contributing to treatment resistance in MDD. In a subset of depressed patients, the balance between pro- and anti-inflammatory cytokines is thought to be altered, causing mood symptoms due to inflammation, as seen in co-morbid depression associated with inflammatory conditions (e.g. psoriasis, hepatitis C, inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis). The objectives of the current narrative review are to critically evaluate the literature about the effects of cytokine blockers on clinical outcomes in MDD and in the reduction of depressive symptom severity in individuals using these medications primarily to treat inflammatory conditions. A small number of clinical trials assessing the effects of cytokine blockers for depression and depressive symptoms have been completed. These trials suggest that in individuals with immune dysfunction (e.g. elevated pro-inflammatory cytokine levels), cytokine blockers may allow for improved clinical outcomes in MDD that would not be achievable with current conventional antidepressants alone. Additional well-designed clinical trials to assess the clinical utility of anti-inflammatory medications for the treatment of depression and depressive symptoms are merited. Further, the use of anti-inflammatories show promise for disease modifying effects that may alter illness trajectory, rather than solely ameliorating current mood symptoms.
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