What is the role of alternative treatments in late-life depression?

Blunted superior temporal gyrus activity to negative emotional expression after mindfulness-based cognitive therapy for late-life depression

Facial emotion recognition plays an important role in social functioning. Patients with late-life depression (LLD) often have abnormal facial emotion recognition. Mindfulness-based cognitive therapy (MBCT) is beneficial in treating depression. This study examined whether MBCT can act as an effective augmentation of antidepressants and improve facial emotion recognition in patients with LLD and its underlying neural mechanism. Patients with LLD were randomized into two groups (n = 30 per group). The MBCT group received an eight-week MBCT in conjunction with stable medication treatment. The other group was treated as usual (TAU group) with stable medication treatment. The positive affect (PA) scale, negative affect (NA) scale, and facial emotion recognition task with an fMRI scan were performed before and after the trial. After eight weeks of treatment, the repeated ANOVA showed that the PA score in the MBCT group significantly increased [F_(1,54) = 13.31, p = 0.001], but did not change significantly [F_(1,54) = 0.58, p = 0.449] in the TAU group. The NA scores decreased significantly in both the MBCT group [F_(1,54) = 19.01, p < 0.001] and the TAU group [F_(1,54) = 16.16, p < 0.001]. Patients showed an increase in recognition accuracy and speed of angry and sad faces after 8 weeks of MBCT. No improvement was detected in the TAU group after treatment. A significant interaction effect was found in the change of activation of the left superior temporal gyrus (L-STG) to negative emotional expression between time and groups. Furthermore, a decrease in activation of L-STG to negative emotional expression was positively correlated with the increase in PA score. The MBCT is beneficial for improving affect status and facial emotion recognition in patients with LLD, and the L-STG is involved in this process.

Mindfulness-Based Cognitive Therapy Regulates Brain Connectivity in Patients With Late-Life Depression

Late-life depression (LLD) is an important public health problem among the aging population. Recent studies found that mindfulness-based cognitive therapy (MBCT) can effectively alleviate depressive symptoms in major depressive disorder. The present study explored the clinical effect and potential neuroimaging mechanism of MBCT in the treatment of LLD. We enrolled 60 participants with LLD in an 8-week, randomized, controlled trial (ChiCTR1800017725). Patients were randomized to the treatment-as-usual (TAU) group or a MBCT+TAU group. The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to evaluate symptoms. Magnetic resonance imaging (MRI) was used to measure changes in resting-state functional connectivity and structural connectivity. We also measured the relationship between changes in brain connectivity and improvements in clinical symptoms. HAMD total scores in the MBCT+TAU group were significantly lower than in the TAU group after 8 weeks of treatment (p < 0.001) and at the end of the 3-month follow-up (p < 0.001). The increase in functional connections between the amygdala and middle frontal gyrus (MFG) correlated with decreases in HAMA and HAMD scores in the MBCT+TAU group. Diffusion tensor imaging analyses showed that fractional anisotropy of the MFG-amygdala significantly increased in the MBCT+TAU group after 8-week treatment compared with the TAU group. Our study suggested that MBCT improves depression and anxiety symptoms that are associated with LLD. MBCT strengthened functional and structural connections between the amygdala and MFG, and this increase in communication correlated with improvements in clinical symptoms. Randomized Controlled Trial; Follow-Up Study; fMRI; Brain Connectivity.

The effect of reflexology massage and passive music therapy intervention before burn dressing on pain, anxiety level and sleep quality

BACKGROUND

The pain, anxiety, and sleep disorders that burn patients experience due to burn dressing negatively affect their treatment process. The aim of this study was to determine the effect of reflexology massage and passive music therapy intervention before burn dressing on pain, anxiety level and sleep quality.

METHODS

This study was a randomized controlled trial. The study sample consisted of 36 patients who were hospitalized in the Burn Center of a University Hospital. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into Reflexology Massage (n = 12), Reflexology Massage with Passive Music Therapy (n = 12) and Control (n = 12) groups using simple random allocation. In the experimental groups, in addition to standard care, interventions were performed for consecutive three days. Interventions were done before dressing for 40 min in the patient's room. The control group received only standard care during this time. Severity of pain in three groups was measured using "Visual Analog Scale" twice a day (before dressing change and 2 h after dressing change). Severity of state anxiety and sleep quality in three groups was measured using "State Anxiety Scale" and "Richards-Campbell Sleep Questionnaire" once a day (before dressing change). Severity of trait anxiety in three groups was measured using "Trait Anxiety Scale" for two times (before and after study). The drugs used by the patients for 3 days were recorded in the "Opioid and Analgesic Drug Form." Data were analyzed using Pearson Chi-square, Independent Samples T-test, One-Way ANOVA, Bonferroni, Paired Sample T-Test, Repeated Measures ANOVA tests were used.

RESULTS

The results showed no significant difference in severity of pain, anxiety, and sleep quality (p > 0,05) between the three groups on the first day. However, the mean pain scores showed a significant difference between the experimental and control groups in the third (p < 0,05) and fourth (p < 0001) days after intervention. Anxiety scores also showed a significant difference between the experimental and control groups on the fourth (p < 0001) day. Sleep quality of the experimental groups was higher than the control group on the fourth day (p < 00001). No significant difference using of opioid and analgesic drugs between the three groups (p > 0,05).

CONCLUSIONS

Our results showed reflexology massage and passive music therapy before burn dressing reduced pain and anxiety level, and increased sleep quality.

The efficacy of combined music therapy and Tai Chi for major depressive disorder: Study protocol for a randomized controlled trial

BACKGROUND

There are no clinical trials evaluating the efficacy of combined music and Tai Chi therapy for patients with major depression. Therefore, the primary objective of the present study was to evaluate the efficacy of Tai Chi and music therapy on psychological status and quality of life among patients with major depressive disorder in China.

METHODS

This work is a part of a comprehensive research project to assess and provide intervention that potentially improves psychological status and quality of life among patients with major depressive disorder. This research project has been received ethical approval from the Medical Research and Ethics Committee in Taizhou Second People's Hospital (no. tzey2020023). After the introductory briefing, the acceptance to take the presession questionnaire implied the participant's consent to participate in the study. Eligible participants are divided into 3 groups according to completely randomized design: combined group (music therapy + Tai Chi), music therapy alone group, and Tai Chi alone group. The analyses will be performed using SPSS 22.0.0 (SPSS Inc, Chicago, IL).

RESULTS

This protocol will provide a reliable theoretical basis for the following research.

CONCLUSION

The sample came from a single health center. Therefore, the results cannot be generalized for the entire population.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry6597).

Treatment Approach and Modalities for Management of Depression in Older People

Depression is common in older people, and while the approach to treatment is similar to a younger population, there are several additional treatment considerations to make based on comorbidities and cognitive impairment. Evidence-based psychotherapies such as cognitive behavioral therapy, interpersonal psychotherapy, and problem-solving therapy are recommended for mild-moderate depression in older people; however, the efficacy of these are limited in very old patients (older than 75 years of age) and those with cognitive impairment. Additionally, neuromodulation treatments such as electroconvulsive therapy and transcranial magnetic stimulation could prove beneficial for specific older people with depression. Use of pharmacotherapy that has demonstrated to be safe in older adults, as well as agents with adequate clinical experience in this population, should be considered based on patient-specific characteristics. Because of generally more complex medication regimens, risks of pharmacotherapy should be minimized with careful dosing strategies and special attention to avoid significant drug-drug interactions. While some data are available, antidepressant combination or augmentation strategies are less well studied in older people who fail to achieve remission or those with treatment-resistant depression, compared with younger populations.

Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials

BACKGROUND

Despite the extensive literature assessing associations between religiosity/spirituality and health, few studies have investigated the clinical applicability of this evidence. The purpose of this paper was to assess the impact of religious/spiritual interventions (RSI) through randomized clinical trials (RCTs).

METHOD

A systematic review was performed in the following databases: PubMed, Scopus, Web of Science, PsycINFO, Cochrane Collaboration, Embase and SciELO. Through the use of a Boolean expression, articles were included if they: (i) investigated mental health outcomes; (ii) had a design consistent with RCTs. We excluded protocols involving intercessory prayer or distance healing. The study was conducted in two phases by reading: (1) title and abstracts; (2) full papers and assessing their methodological quality. Then, a meta-analysis was carried out.

RESULTS

Through this method, 4751 papers were obtained, of which 23 remained included. The meta-analysis showed significant effects of RSI on anxiety general symptoms (p < 0.001) and in subgroups: meditation (p < 0.001); psychotherapy (p = 0.02); 1 month of follow-up (p < 0.001); and comparison groups with interventions (p < 0.001). Two significant differences were found in depressive symptoms: between 1 and 6 months and comparison groups with interventions (p = 0.05). In general, studies have shown that RSI decreased stress, alcoholism and depression.

CONCLUSIONS

RCTs on RSI showed additional benefits including reduction of clinical symptoms (mainly anxiety). The diversity of protocols and outcomes associated with a lack of standardization of interventions point to the need for further studies evaluating the use of religiosity/spirituality as a complementary treatment in health care.

Recognizing depression in late life

Depression presents differently in older adults than in younger adults and frequently occurs with many chronic illnesses in later life, though it is not a normal part of aging. The astute practitioner will screen for depression in this population and appropriately treat to improve chronic illness management and quality of life in older adults.

Strategies for successful aging: a research update

Population aging is an enormous public health issue and there is clear need for strategies to maximize opportunities for successful aging. Many psychiatric illnesses are increasingly thought to be associated with accelerated aging, therefore emerging data on individual and policy level interventions that alter typical aging trajectories are relevant to mental health practitioners. Although the determinants and definition of successful aging remain controversial, increasing data indicate that psychiatric illnesses directly impact biological aging trajectories and diminish lifestyle, psychological, and socio-environmental factors that seem to reduce risk of morbidity and mortality. Many interventions designed to enhance the normal course of aging may be adjunctive approaches to management of psychiatric illnesses. We highlight recent data on interventions seeking to promote healthy aging, such as cognitive remediation, physical activity, nutrition, and complementary and alternative treatments for older people with and without psychiatric illnesses.

Abuse and misuse of antidepressants

BACKGROUND

Rates of prescription drug abuse have reached epidemic proportions. Large-scale epidemiologic surveys of this under-recognized clinical problem have not included antidepressants despite their contribution to morbidity and mortality. The purpose of this review is to look specifically at the misuse of antidepressants and how this behavior may fit into the growing crisis of nonmedical use of prescription drugs.

METHODS

We conducted a comprehensive search on PubMed, Medline, and PsycINFO using the search terms "antidepressant", "abuse", "misuse", "nonmedical use", "dependence", and "addiction", as well as individual antidepressant classes (eg, "SSRI") and individual antidepressants (eg, "fluoxetine") in various combinations, to identify articles of antidepressant misuse and abuse.

RESULTS

A small but growing literature on the misuse and abuse of antidepressants consists largely of case reports. Most cases of antidepressant abuse have occurred in individuals with comorbid substance use and mood disorders. The most commonly reported motivation for abuse is to achieve a psychostimulant-like effect. Antidepressants are abused at high doses and via a variety of routes of administration (eg, intranasal, intravenous). Negative consequences vary based upon antidepressant class and pharmacology, but these have included seizures, confusion, and psychotic-like symptoms.

CONCLUSION

The majority of individuals prescribed antidepressants do not misuse the medication. However, certain classes of antidepressants do carry abuse potential. Vulnerable patient populations include those with a history of substance abuse and those in controlled environments. Warning signs include the presence of aberrant behaviors. Physicians should include antidepressants when screening for risky prescription medication use. When antidepressant misuse is detected, a thoughtful treatment plan, including referral to an addiction specialist, should be developed and implemented.