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Thai M, Nair AU, Klimes-Dougan B, Albott CS, Silamongkol T, Corkrum M, Hill D, Roemer JW, Lewis CP, Croarkin PE, Lim KO, Widge AS, Nahas Z, Eberly LE, Cullen KR. Deep transcranial magnetic stimulation for adolescents with treatment-resistant depression: A preliminary dose-finding study exploring safety and clinical effectiveness. J Affect Disord 2024; 354:589-600. [PMID: 38484878 PMCID: PMC11163675 DOI: 10.1016/j.jad.2024.03.061] [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: 04/18/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an intervention for treatment-resistant depression (TRD) that modulates neural activity. Deep TMS (dTMS) can target not only cortical but also deeper limbic structures implicated in depression. Although TMS has demonstrated safety in adolescents, dTMS has yet to be applied to adolescent TRD. OBJECTIVE/HYPOTHESIS This pilot study evaluated the safety, tolerability, and clinical effects of dTMS in adolescents with TRD. We hypothesized dTMS would be safe, tolerable, and efficacious for adolescent TRD. METHODS 15 adolescents with TRD (Age, years: M = 16.4, SD = 1.42) completed a six-week daily dTMS protocol targeting the left dorsolateral prefrontal cortex (BrainsWay H1 coil, 30 sessions, 10 Hz, 3.6 s train duration, 20s inter-train interval, 55 trains; 1980 total pulses per session, 80 % to 120 % of motor threshold). Participants completed clinical, safety, and neurocognitive assessments before and after treatment. The primary outcome was depression symptom severity measured by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS 14 out of 15 participants completed the dTMS treatments. One participant experienced a convulsive syncope; the other participants only experienced mild side effects (e.g., headaches). There were no serious adverse events and minimal to no change in cognitive performance. Depression symptom severity significantly improved pre- to post-treatment and decreased to a clinically significant degree after 10 treatment sessions. Six participants met criteria for treatment response. LIMITATIONS Main limitations include a small sample size and open-label design. CONCLUSIONS These findings provide preliminary evidence that dTMS may be tolerable and associated with clinical improvement in adolescent TRD.
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Affiliation(s)
- Michelle Thai
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Aparna U Nair
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America
| | - C Sophia Albott
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Thanharat Silamongkol
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Michelle Corkrum
- Columbia University Medical Center, New York, NY, United States of America
| | - Dawson Hill
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Justin W Roemer
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Charles P Lewis
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
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Garel N, Nazon M, Naghi K, Willis E, Looper K, Rej S, Greenway KT. Ketamine for depression: a potential role in requests for Medical Aid in Dying? Int Clin Psychopharmacol 2023; 38:352-355. [PMID: 37159173 DOI: 10.1097/yic.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Medical Aid in Dying (MAiD) is the act of a healthcare provider ending a patient's life, at their request, due to unbearable suffering from a grievous and incurable disease. Access to MAiD has expanded in the last decade and, more recently, it has been made available for psychiatric illnesses in a few countries. Recent studies have found that such psychiatric requests are rapidly increasing and primarily involve mood disorders as the primary condition. Nevertheless, MAiD for psychiatric disorders is associated with significant controversy and debate, especially regarding the definition and determination of irremediability - that a given patient lacks any reasonable prospect for recovery. In this article, we report the case of a Canadian patient who was actively requesting Medical Assistance in Dying for severe and prolonged treatment-resistant depression until she experienced remarkable benefits from a course of intravenous ketamine infusions. To our knowledge, this is the first report of ketamine or any other intervention yielding remission in a patient who would have otherwise likely been eligible for MAiD for depression. We discuss implications for the evaluation of similar requests and, more specifically, why a trial of ketamine warrants consideration.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
| | | | - Kamran Naghi
- Department of Psychiatry, Jewish General Hospital
| | - Elena Willis
- Department of Psychiatry, Jewish General Hospital
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
- Department of Psychiatry, McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
- Department of Psychiatry, McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec, Canada
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Kwaśny A, Włodarczyk A, Ogonowski D, Cubała WJ. Effect of Ketamine on Sleep in Treatment-Resistant Depression: A Systematic Review. Pharmaceuticals (Basel) 2023; 16:568. [PMID: 37111325 PMCID: PMC10143949 DOI: 10.3390/ph16040568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Depression is a debilitating disease with a high socioeconomic burden. Regular antidepressants usually require several weeks to ameliorate symptoms; however, numerous patients do not achieve remission. What is more, sleep disturbances are one of the most common residual symptoms. Ketamine is a novel antidepressant with rapid onset of action with a proven antisuicidal effect. Little is known about its impact on sleep-wake and circadian rhythm alterations. The aim of this systematic review is to research the impact ketamine has on sleep disturbances in depression. METHODS PubMed, Web of Science, and APA PsycINFO were searched for relevant studies on ketamine's impact on sleep disturbances in depression. Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA2020 methodology was applied. The systematic review protocol was registered in the PROSPERO Registry (CRD42023387897). RESULTS Five studies were included in this review. Two studies reported significant improvement in sleep measured by MADRS (Montgomery-Åsberg Depression Rating Scale) and QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report (16-item)) scales after intravenous ketamine and intranasal esketamine administration. One case report showed mitigation of symptoms in PSQI (Pittsburgh Sleep Quality Index) and ISI (Insomnia Severity Index) during 3-month treatment with esketamine. In two studies, sleep was objectively measured by nocturnal EEG (electroencephalography) and showed a decrease in nocturnal wakefulness accompanied by an increase in slow wave (SWS) and rapid eye movement (REM) sleep. CONCLUSION Ketamine reduces the severity of sleep insomnia in depression. Robust data are lacking. More research is needed.
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Affiliation(s)
- Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdańsk, Poland
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Jang SH, Bahk WM, Woo YS, Seo JS, Park YM, Kim W, Jeong JH, Shim SH, Lee JG, Jon DI, Min KJ. The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD): Changes in Preferred Treatment Strategies and Medications over 20 Years and Five Editions. J Clin Med 2023; 12:jcm12031146. [PMID: 36769798 PMCID: PMC9917906 DOI: 10.3390/jcm12031146] [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: 12/06/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is an expert consensus guideline for depressive disorder created in 2002, and since then, four revisions (2006, 2012, 2017, 2021) have been published. In this study, changes in the content of the KMAP-DD survey and recommendations for each period were examined. METHODS The development process of the KMAP-DD was composed of two stages. First, opinions from experts with abundant clinical experience were gathered through surveys. Next, a final guideline was prepared through discussion within the working committee regarding the suitability of the results with reference to recent clinical studies or other guidelines. RESULTS In mild depressive symptoms, antidepressant (AD) monotherapy was preferred, but when severe depression or when psychotic features were present, a combination of AD and atypical antipsychotics (AD + AAP) was preferred. AD monotherapy was preferred in most clinical subtypes. AD monotherapy was preferred for mild depressive symptoms, and AD + AAP was preferred for severe depression and depression with psychotic features in children, adolescents, and the elderly. CONCLUSIONS This study identified the changes in the KMAP-DD treatment strategies and drug preferences in each period over the past 20 years. This work is expected to aid clinicians in establishing effective treatment strategies.
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Affiliation(s)
- Seung-Ho Jang
- Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence:
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Won Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
| | - Jung Goo Lee
- Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan 48108, Republic of Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kyung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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ERK/mTOR signaling may underlying the antidepressant actions of rapastinel in mice. Transl Psychiatry 2022; 12:522. [PMID: 36550125 PMCID: PMC9780240 DOI: 10.1038/s41398-022-02290-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Rapastinel as the allosteric modulator of N-methyl-D-aspartate receptor (NMDAR) produces rapid antidepressant-like effects dependent on brain-derived neurotrophic factor (BDNF) and VGF (nonacryonimic) release. Herein, we further explore the molecular mechanisms of the antidepressant effects of repeated administration with rapastinel in mice. Our results showed that continuous 3-day rapastinel (5 and 10 mg/kg, i.v.) produced antidepressant-like actions dependent on the increase in extracellular regulated protein kinase (ERK)/mammalian target of rapamycin (mTOR) signaling and downstream substrates p70S6 kinase (p70S6k) and the eukaryotic initiation factor 4E-binding protein 1 (4E-BP1), which may induce the expression of VGF and BDNF in the hippocampus and prefrontal cortex of mice. Furthermore, compared with a single treatment, our data indicated that 3-day repeated rapastinel treatment produced antidepressant-like actions accompanied by potentiation of ERK/mTOR/VGF/BDNF/tropomyosin-related kinase receptor B (TrkB) signaling. Based on previous and our supplementary data that showed the pivotal role of on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) in the rapid release of VGF and BDNF and activation of TrkB by a single dose of rapastinel, we postulate that the antidepressant-like effects of single or repeated administration of rapastinel may result in the rapid release of VGF and BDNF or ERK/mTOR signaling pathway-mediated VGF/BDNF/TrkB autoregulatory feedback loop respectively. Our current work adds new knowledge to the molecular mechanisms that underlie the antidepressant-like actions of rapastinel in mice.
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German-Ponciano LJ, Rosas-Sánchez GU, Cueto-Escobedo J, Fernández-Demeneghi R, Guillén-Ruiz G, Soria-Fregozo C, Herrera-Huerta EV, Rodríguez-Landa JF. Participation of the Serotonergic System and Brain-Derived Neurotrophic Factor in the Antidepressant-like Effect of Flavonoids. Int J Mol Sci 2022; 23:ijms231810896. [PMID: 36142808 PMCID: PMC9505567 DOI: 10.3390/ijms231810896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Depressive disorders are among the most disabling diseases experienced around the world, and their incidence has significantly increased over the last few decades due to multiple environmental, social, and biological factors. The search for new pharmacological alternatives to treat depression is a global priority. In preclinical research, molecules obtained from plants, such as flavonoids, have shown promising antidepressant-like properties through several mechanisms of action that have not been fully elucidated, including crossing of the blood brain barrier (BBB). This review will focus on discussing the main findings related to the participation of the serotonergic system and brain-derived neurotrophic factor (BDNF) on the antidepressant-like effect of some flavonoids reported by behavioral, neurochemical, and molecular studies. In this sense, evidence shows that depressive individuals have low levels of serotonin and BDNF, while flavonoids can reverse it. Finally, the elucidation of the mechanism used by flavonoids to modulate serotonin and BDNF will contribute to our understanding of the neurobiological bases underlying the antidepressant-like effects produced by these natural compounds.
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Affiliation(s)
| | | | - Jonathan Cueto-Escobedo
- Departamento de Investigación Clínica y Traslacional Instituto de Ciencias de la Salud, Universidad Veracruzana, Xalapa 91190, Mexico
| | | | - Gabriel Guillén-Ruiz
- Programa de Investigadoras e Investigadores por México CONACyT-Instituto de Neuroetología, Universidad Veracruzana, Xalapa 91190, Mexico
| | - César Soria-Fregozo
- Centro Universitario de Los Lagos, Universidad de Guadalajara, Lagos de Moreno 47460, Mexico
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The Sirtuin 2 Inhibitor AK-7 Leads to an Antidepressant-Like Effect in Mice via Upregulation of CREB1, BDNF, and NTRK2 Pathways. Mol Neurobiol 2022; 59:7036-7044. [PMID: 36074231 DOI: 10.1007/s12035-022-03026-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
Depression is one of the most important and serious health problems in developing countries which affects millions of people. It is associated with the decrease of the quality of life as well as suicides and mortality. The disease may show recurrent episodes in some patients. Obviously, not all the patients with depression could be treated properly, because some individuals are drug-resistant and the options for the therapy are limited. Therefore, it is crucial to investigate new molecules and pathways that may have possible antidepressant activity. Sirtuin (SIRT), known as a class III histone deacetylase, which is regulated by nicotinamide adenine dinucleotide (NAD +), is one of these molecules. In the current study, we investigated the possible antidepressant-like effect of SIRT2 inhibitor AK-7. For this purpose, behavioral tests were performed in chronic AK-7-treated mice, and the expression levels of BDNF, NGF, NTF3, CREB, NTRK2, ERK1, ERK2, and GAP43 genes were evaluated by qRT-PCR analysis in brain tissues. Protein levels for BDNF, CREB1, and NTRK2 were determined by western blot. Our data showed that AK-7 significantly decreased immobility time and showed antidepressant-like effect. In addition, AK-7 treatment significantly increased mRNA levels of CREB and NTRK2 and protein levels of CREB1, BDNF, and NTRK2. Finally, our results suggest that SIRT2 and AK-7 may have a potential role in the cellular mechanisms of depression.
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Chan LF, Woon LSC, Mohd Shukor NA, Eu CL, Ismail N, Chin SJ, Nik Jaafar NR, Baharudin A. Case report: Effectiveness of brexpiprazole and esketamine/ketamine combination: A novel therapeutic strategy in five cases of treatment-resistant depression. Front Psychiatry 2022; 13:890099. [PMID: 35966463 PMCID: PMC9373837 DOI: 10.3389/fpsyt.2022.890099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.
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Affiliation(s)
- Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Luke Sy-Cherng Woon
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nuur Asyikin Mohd Shukor
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Choon Leng Eu
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nurazah Ismail
- Psychiatry Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Song Jie Chin
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Azlin Baharudin
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Chee KY, Muhdi N, Ali NH, Amir N, Bernardo C, Chan LF, Ho R, Ittasakul P, Kwansanit P, Mariano MP, Mok YM, Tran DT, Trinh TBH. A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age. BMC Psychiatry 2022; 22:489. [PMID: 35864465 PMCID: PMC9306096 DOI: 10.1186/s12888-022-04140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. METHODS A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. RESULTS Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification - incorporating both severity and temporality, or using a prevention-focused risk formulation - should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. CONCLUSIONS There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.
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Affiliation(s)
- Kok Yoon Chee
- NEURON, Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
| | - Nalini Muhdi
- Department of Psychiatry, Dr Soetomo General Hospital; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Nor Hayati Ali
- Department of Psychiatry & Mental Health, Selayang Hospital, Selayang, Selangor, Malaysia
| | - Nurmiati Amir
- Department of Psychiatry, Ciptomangunkusumo Hospital; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carmina Bernardo
- Mood and Anxiety Resource and Referral Center, Professional Services, Department of Neuroscience, Makati Medical Center, Makati City, Philippines
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roger Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Melissa Paulita Mariano
- Department of Psychiatry, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Yee Ming Mok
- Institute of Mental Health, Singapore, Singapore
| | - Duy Tam Tran
- Ho Chi Minh Psychiatric Hospital, Ho Chi Minh, Vietnam
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Astuti P, Khairan K, Marthoenis M, Hasballah K. Antidepressant-like Activity of Patchouli Oil var. Tapak Tuan ( Pogostemon cablin Benth) via Elevated Dopamine Level: A Study Using Rat Model. Pharmaceuticals (Basel) 2022; 15:608. [PMID: 35631434 PMCID: PMC9145128 DOI: 10.3390/ph15050608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Essential oils are gaining popularity for their use in treating depression, including that extracted from patchouli leaves and stems (Pogostemon cablin). Herein, we used patchouli oil (PO) containing a high amount of patchouli alcohol derived from P. cablin var. Tapak Tuan. The aim of this study was to investigate the antidepressant potential of PO, with a variety of patchouli alcohol concentrations obtained from a separation process using vacuum distillation with different temperature ranges. The initial patchouli oil (iPO) was traditionally distilled by a local farmer and further distilled using a rotary evaporator at temperature ranges of 115−160 °C (POF-1); 120−160 °C (POF-2), and 125−160 °C (POF-3), resulting in products with different patchouli alcohol concentrations. POF-3, with the highest patchouli alcohol content of 60.66% (based on gas chromatography-mass spectrometry), was used for cooling crystallization, resulting in 100% patchouli alcohol crystal (pPA). A tail suspension test (TST) was performed on a rat model to screen the antidepressant potential of iPO and its derivatives. The TST results revealed that POF-3 had the best antidepressant-like effect and was second only to the fluoxetine-based antidepressant, Kalxetin®, where both groups had significant reductions of immobility time post-treatment (p < 0.0001). Other than patchouli alcohol, POF-3 also contained ledol and trans-geraniol, which have been reported for their antidepressant-related activities. Brain dopamine levels increased significantly in the group treated with POF-3 (p < 0.05 as compared with the control group), suggesting its primary anti-depressant mechanism. These findings suggest the potential of vacuum-distilled patchouli oil in reducing depression via dopamine elevation.
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Affiliation(s)
- Puji Astuti
- Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
- LLDikti Wilayah XIII, Aceh Besar 23352, Indonesia
- Department of Psychiatry and Mental Health Nursing, Akademi Keperawatan Tgk. Fakinah, Banda Aceh 23232, Indonesia
- Atsiri Research Centre, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
| | - Khairan Khairan
- Atsiri Research Centre, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
- Department of Pharmacy, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- PT-PUI Nilam Aceh, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Pusat Riset Obat Herbal, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Marthoenis Marthoenis
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
| | - Kartini Hasballah
- Department of Pharmacology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
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11
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Arbelaez Ossa L, Starke G, Lorenzini G, Vogt JE, Shaw DM, Elger BS. Re-focusing explainability in medicine. Digit Health 2022; 8:20552076221074488. [PMID: 35173981 PMCID: PMC8841907 DOI: 10.1177/20552076221074488] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Using artificial intelligence to improve patient care is a cutting-edge methodology, but its implementation in clinical routine has been limited due to significant concerns about understanding its behavior. One major barrier is the explainability dilemma and how much explanation is required to use artificial intelligence safely in healthcare. A key issue is the lack of consensus on the definition of explainability by experts, regulators, and healthcare professionals, resulting in a wide variety of terminology and expectations. This paper aims to fill the gap by defining minimal explainability standards to serve the views and needs of essential stakeholders in healthcare. In that sense, we propose to define minimal explainability criteria that can support doctors’ understanding, meet patients’ needs, and fulfill legal requirements. Therefore, explainability need not to be exhaustive but sufficient for doctors and patients to comprehend the artificial intelligence models’ clinical implications and be integrated safely into clinical practice. Thus, minimally acceptable standards for explainability are context-dependent and should respond to the specific need and potential risks of each clinical scenario for a responsible and ethical implementation of artificial intelligence.
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Affiliation(s)
| | - Georg Starke
- Institute for Biomedical Ethics, University of Basel, Switzerland.,College of Humanities, École Polytechnique Fédérale de Lausanne, Switzerland
| | | | - Julia E Vogt
- Department of Computer Science, ETH Zurich, Switzerland
| | - David M Shaw
- Institute for Biomedical Ethics, University of Basel, Switzerland.,Care and Public Health Research Institute, Maastricht University, Netherlands
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Switzerland.,Center for Legal Medicine (CURML), University of Geneva, Switzerland
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12
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Baune BT, Falkai P. Changes in antidepressant therapy should be considered early in patients with inadequate response to a first-line agent. Aust N Z J Psychiatry 2021; 55:1033-1038. [PMID: 33111538 DOI: 10.1177/0004867420968912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Deciding when and how to change treatment in patients with major depressive disorder who have inadequate response to initial antidepressant therapy is an important everyday clinical question. Here, we ask whether an early change of approach is superior to a delayed change. We consider the recommendations provided by recent guidelines, examine the evidence behind this guidance and suggest a decision tree to clarify treatment options and timing. Both the early and late-change strategies may have their place in clinical practice. However, we take the view that an earlier than currently usual change in antidepressant treatment should be considered more frequently in cases of non-response. Specific studies are needed to identify and to better understand predictors of early and late response.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
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13
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Zhao FF. Artificial neural network application for identifying risk of depression in high school students: a cross-sectional study. BMC Psychiatry 2021; 21:517. [PMID: 34670532 PMCID: PMC8527661 DOI: 10.1186/s12888-021-03531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identifying important factors contributing to depression is necessary for interrupting risk pathways to minimize adolescent depression. The study aimed to assess the prevalence of depression in high school students and develop a model for identifying risk of depression among adolescents. METHODS Cross-sectional study was conducted. A total of 1190 adolescents from two high schools in eastern China participated in the study. Artificial neurol network (ANN) was used to establish the identification model. RESULTS The prevalence of depression was 29.9% among the students. The model showed the top five protective and risk factors including perceived stress, life events, optimism, self-compassion and resilience. ANN model accuracy was 81.06%, with sensitivity 65.3%, specificity 88.4%, and area under the receiver operating characteristic (ROC) curves 0.846 in testing dataset. CONCLUSION The ANN showed the good performance in identifying risk of depression. Promoting the protective factors and reducing the level of risk factors facilitate preventing and relieving depression.
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Affiliation(s)
- Fang-Fang Zhao
- Department of Nursing Science, Faculty of Medicine, Nantong University, Nantong, 0086-226001, Jiangsu Province, China.
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14
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Abstract
The efficacy of standard antidepressants is limited for many patients with mood disorders such as major depressive disorder (MDD) and bipolar depression, underscoring the urgent need to develop novel therapeutics. Both clinical and preclinical studies have implicated glutamatergic system dysfunction in the pathophysiology of mood disorders. In particular, rapid reductions in depressive symptoms have been observed in response to subanesthetic doses of the glutamatergic modulator racemic (R,S)-ketamine in individuals with mood disorders. These results have prompted investigation into other glutamatergic modulators for depression, both as monotherapy and adjunctively. Several glutamate receptor-modulating agents have been tested in proof-of-concept studies for mood disorders. This manuscript gives a brief overview of the glutamate system and its relevance to rapid antidepressant response and discusses the existing clinical evidence for glutamate receptor-modulating agents, including (1) broad glutamatergic modulators ((R,S)-ketamine, esketamine, (R)-ketamine, (2R,6R)-hydroxynorketamine [HNK], dextromethorphan, Nuedexta [a combination of dextromethorphan and quinidine], deudextromethorphan [AVP-786], axsome [AXS-05], dextromethadone [REL-1017], nitrous oxide, AZD6765, CLE100, AGN-241751); (2) glycine site modulators (D-cycloserine [DCS], NRX-101, rapastinel [GLYX-13], apimostinel [NRX-1074], sarcosine, 4-chlorokynurenine [4-Cl-KYN/AV-101]); (3) subunit (NR2B)-specific N-methyl-D-aspartate (NMDA) receptor antagonists (eliprodil [EVT-101], traxoprodil [CP-101,606], rislenemdaz [MK-0657/CERC-301]); (4) metabotropic glutamate receptor (mGluR) modulators (basimglurant, AZD2066, RG1578, TS-161); and (5) mammalian target of rapamycin complex 1 (mTORC1) activators (NV-5138). Many of these agents are still in the preliminary stages of development. Furthermore, to date, most have demonstrated relatively modest effects compared with (R,S)-ketamine and esketamine, though some have shown more favorable characteristics. Of these novel agents, the most promising, and the ones for which the most evidence exists, appear to be those targeting ionotropic glutamate receptors.
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15
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 264] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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16
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Ballard ED, Zarate CA. The role of dissociation in ketamine's antidepressant effects. Nat Commun 2020; 11:6431. [PMID: 33353946 PMCID: PMC7755908 DOI: 10.1038/s41467-020-20190-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Ketamine produces immediate antidepressant effects and has inspired research into next-generation treatments. Ketamine also has short term dissociative effects, in which individuals report altered consciousness and perceptions of themselves and their environment. However, whether ketamine's dissociative side effects are necessary for its antidepressant effects remains unclear. This perspective examines the relationship between dissociative effects and acute and longer-lasting antidepressant response to ketamine and other N-methyl-D-aspartate (NMDA) receptor antagonists. Presently, the literature does not support the conclusion that dissociation is necessary for antidepressant response to ketamine. However, further work is needed to explore the relationship between dissociation and antidepressant response at the molecular, biomarker, and psychological levels.
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Affiliation(s)
- Elizabeth D Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
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