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Rahangdale S, Deshmukh P, Sammeta S, Aglawe M, Kale M, Umekar M, Kotagale N, Taksande B. Agmatine modulation of gut-brain axis alleviates dysbiosis-induced depression-like behavior in rats. Eur J Pharmacol 2024; 981:176884. [PMID: 39134294 DOI: 10.1016/j.ejphar.2024.176884] [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: 01/16/2024] [Revised: 07/20/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
Depression is a global health concern affecting nearly 280 million individuals. It not only imposes a significant burden on economies and healthcare systems but also manifests complex physiological connections and consequences. Agmatine, a putative neuromodulator derived primarily from beneficial gut microbes specially Lactobacillus, has emerged as a potential therapeutic agent for mental health. The microbiota-gut-brain axis is involved in the development of depression through the peripheral nervous system, endocrine system, and immune system and may be a key factor in the effect of agmatine. Therefore, this study aimed to investigate the potential mechanism of agmatine in antibiotic-induced dysbiosis and depression-like behavior in rats, focusing on its modulation of the gut-brain axis. Depression-like behavior associated with dysbiosis was induced through a seven-day regimen of the broad-spectrum antibiotic, comprising ampicillin and metronidazole and validated through microbial, biochemical, and behavioral alterations. On day 8, antibiotic-treated rats exhibited loose fecal consistency, altered fecal microbiota, and depression-like behavior in forced swim test. Pro-inflammatory cytokines were elevated, while agmatine and monoamine levels decreased in the hippocampus and prefrontal cortex. Antibiotic administration disrupted tight junction proteins in the ileum, affecting gut architecture. Oral administration of agmatine alone or combined with probiotics significantly reversed antibiotic-induced dysbiosis, restoring gut microbiota and mitigating depression-like behaviors. This intervention also restored neuro-inflammatory markers, increased agmatine and monoamine levels, and preserved gut integrity. The study highlights the regulatory role of endogenous agmatine in the gut-brain axis in broad-spectrum antibiotic induced dysbiosis and associated depression-like behavior.
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Affiliation(s)
- Sandip Rahangdale
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Pankaj Deshmukh
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Shivkumar Sammeta
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Manish Aglawe
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Mayur Kale
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Milind Umekar
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India
| | - Nandkishor Kotagale
- Government College of Pharmacy, Kathora Naka, VMV Road, Amravati, M.S., 44604, India
| | - Brijesh Taksande
- Division of Neuroscience, Department of Pharmacology, Smt. Kishoritai Bhoyar College of Pharmacy, New Kamptee, Nagpur, M.S., 441 002, India.
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Burkhardt G, Blackwell SE, Chen M, Feldmann L, Björklund J, Dechantsreiter E, Bulubas L, Goerigk S, Keeser D, Falkai P, Greimel E, Bechmann P, Schulte-Körne G, Hasan A, Strube W, Padberg F. Intermittent theta burst stimulation in adolescents and young adults with depressive disorders: protocol of a randomized, sham-controlled study with a sequential Bayesian design for adaptive trials. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01926-5. [PMID: 39387918 DOI: 10.1007/s00406-024-01926-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 10/02/2024] [Indexed: 10/15/2024]
Abstract
Intermittent theta burst stimulation (iTBS), a variant of repetitive transcranial magnetic stimulation (rTMS), is an established treatment for adults with major depressive disorder (MDD). Due to its favorable safety profile, iTBS is also a promising early intervention in the transition phase from adolescence to early adulthood, but this has not been systematically investigated to date. Thus, the EARLY-BURST trial investigates the efficacy and safety of iTBS over the left dorsolateral prefrontal cortex (lDLPFC) in treatment-seeking young patients (age 16-26 years) with depressive disorders (i.e. major depressive disorder, persistent depressive disorder, bipolar depression), allowing for relevant co-morbidities. Participants have not received antidepressant or antipsychotic medication during the last 12 months except for short-term (< 2 weeks) on-demand medication. The trial will employ a novel sequential Bayesian, randomized, double-blind, parallel-group, sham-controlled design. Up to 90 patients at two clinical sites (Munich, Augsburg) will be randomized 1:1 to the treatment groups, with sequential analyses starting after 26 patients in each group completed the treatment. The primary outcome will be the difference in depression severity at week 6 (post-treatment visit) between active iTBS and sham iTBS, assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). The trial is planned to be expanded towards a three-arm leapfrog design, contingent on securing additional funding. Thus, in addition to potentially providing evidence of iTBS's efficacy in adolescents and young adults with depressive disorders, the EARLY-BURST trial aims at setting the stage for subsequent platform trials in this dynamic research field, where novel adaptive study designs are required to meet the need for rapidly testing promising new vs established rTMS protocols.Trial registration: DRKS00033313.
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Affiliation(s)
- Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany.
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany.
| | - Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Institute of Psychology, Georg-August-University of Göttingen, Göttingen, Germany
| | - Miaoxi Chen
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Lisa Feldmann
- Dept. of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Jonas Björklund
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- Charlotte Fresenius Hochschule, University of Psychology, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Ellen Greimel
- Dept. of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Peter Bechmann
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Gerd Schulte-Körne
- Dept. of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Munich, Germany
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Arango C, Fegert JM, Picarel-Blanchot F, Marx U, Truffaut-Chalet L, Pénélaud PF, Buitelaar J. Agomelatine in pediatric patients with moderate to severe major depressive disorder: an open-label extension study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02587-4. [PMID: 39390266 DOI: 10.1007/s00787-024-02587-4] [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: 06/16/2023] [Accepted: 09/28/2024] [Indexed: 10/12/2024]
Abstract
Major depressive disorder (MDD) in young people is a common psychiatric disorder, but treatment options are limited. Agomelatine has demonstrated short-term efficacy and safety in pediatric patients. We report here the results of a 92-week open-label extension (OLE). The international, multicenter, double-blind, study randomized 400 patients (80 children, 320 adolescents) with moderate-to-severe MDD to one of four treatment groups: agomelatine 10 mg (n = 102), agomelatine 25 mg (n = 95), placebo (n = 103), and fluoxetine 10-20 mg (n = 100). After 12 weeks, patients who could benefit from treatment continuation were offered entry into an optional OLE during which they received agomelatine 10 or 25 mg for a further 92 weeks. A total of 339 patients (271 adolescents) entered the OLE. Treatment groups considered for the OLE analysis reflected those received in the double-blind and OLE periods: agomelatine (10 or 25 mg) in both (ago/ago, n = 170); placebo then agomelatine 10-25 mg (pcb/ago, n = 85); or fluoxetine then agomelatine 10-25 mg (fluox/ago, n = 84). Mean age (± SD) at entry into the double-blind phase (Week 0) was 13.6 ± 2.7 years and 61.9% were female. Mean changes in Children's Depression Rating Scale revised (CDRS-R) raw total score from Week 12 to last post-Week 12 value in the three groups were - 16.3 ± 12.2 (ago/ago), - 18.9 ± 16.1 (pcb/ago), and - 16.1 ± 15.5 (fluox/ago), reflecting the difference in efficacy between treatments during the double-blind period, and heterogeneity at W12 between the treatment groups. Adverse events considered related to treatment occurred in 14.5% of patients: 15.3% ago/ago, 16.5% pcb/ago, and 10.7% fluox/ago. Three patients (all adolescents) experienced treatment-related severe adverse events: two treated with ago/ago and one treated with pcb/ago. Among the adolescents, one treatment-related severe adverse event in a patient in the pcb/ago group led to study withdrawal. Agomelatine was associated with continuous improvement in depressive symptoms without unexpected safety signals. These findings support the safe use of agomelatine in a pediatric population with moderate-to-severe MDD for up to 104 weeks.Trial registration No: EUDRACT No. 2015-002181-23.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Joerg M Fegert
- Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Germany
| | | | - Ute Marx
- Servier Forschung und Pharmaentwicklung, Munich, Germany.
| | | | | | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
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Maneeton P, Maneeton B, Winichaikul Y, Kawilapat S, Kienngam N, Maneeton N. Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials: Antidepressants for Restricted and Repetitive Behaviors in Autism Spectrum Disorder. Neuropsychiatr Dis Treat 2024; 20:1711-1723. [PMID: 39372877 PMCID: PMC11456297 DOI: 10.2147/ndt.s465611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/20/2024] [Indexed: 10/08/2024] Open
Abstract
In previously randomized controlled trials (RCTs) on the efficacy of antidepressants in restricted and repetitive behaviors (RRBs) in autism spectrum disorder (ASD), outcomes overwhelmingly showed no benefits of antidepressants studied in the larger multisite RCTs over placebo. However, the positive effect of antidepressants in the RRBs found in the small preliminary studies requires confirmation in larger trials. We aimed to systematically review the efficacy of antidepressants in the treatment of RRBs in ASD by including RCTs from the SCOPUS, PubMed, Embase, Cochrane Controlled Trials Register, Clinical Trials.gov, and other databases in January 2024. Analyzing data from 609 participants across nine RCTs showed no significant difference in the overall pooled mean-end score for RRBs between antidepressant- and placebo-treated groups [SMD (95% CI) of -0.25 (-0.53, 0.02), I2 = 54%, Tau2 = 0.10, prediction interval = -1.03, 0.53]. In small preliminary studies by one group, the clomipramine-treated group's pooled mean endpoint for obsessive-compulsive symptoms in ASD individuals showed a significantly better outcome than the desipramine-treated group, but in unconfirmed studies. Of the individual antidepressants investigated only clomipramine, and fluvoxamine illustrated some efficacy over placebo in small preliminary studies. These findings need confirmation in larger, multisite randomized controlled trials. There were no significant differences in the overall discontinuation rates or discontinuation due to adverse events between the antidepressant- and placebo-treated groups [RR (95% CI) of 1.30 (0.95, 1.78), I2 = 0%, and 1.33 (0.71, 2.47), I2=0%, respectively]. Common side effects included agitation, appetite disturbance, anorexia, gastrointestinal issues, and sleep disturbance, with no significant differences between the antidepressant and placebo groups. In conclusion, the results regarding the efficacy of antidepressants in the treatment of RRBs in ASD are inconsistent. Since previous evidence found a correlation between attention-deficit hyperactivity disorder (ADHD) symptoms including overactivity and impulsivity, and RRBs, further trials including the use of non-stimulants such as atomoxetine could be conducted.
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Affiliation(s)
- Prapinpatch Maneeton
- Chiang Mai University Demonstration School, Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Suttipong Kawilapat
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nongluck Kienngam
- Department of Education Psychology and Guidance Program, Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Solmi M, Miola A, Capone F, Pallottino S, Højlund M, Firth J, Siskind D, Holt RIG, Corbeil O, Cortese S, Dragioti E, Du Rietz E, Nielsen RE, Nordentoft M, Fusar-Poli P, Hartman CA, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Vieta E, Taipale H, Correll CU. Risk factors, prevention and treatment of weight gain associated with the use of antidepressants and antipsychotics: a state-of-the-art clinical review. Expert Opin Drug Saf 2024; 23:1249-1269. [PMID: 39225182 DOI: 10.1080/14740338.2024.2396396] [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: 01/05/2023] [Revised: 06/12/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION People with severe mental illness have poor cardiometabolic health. Commonly used antidepressants and antipsychotics frequently lead to weight gain, which may further contribute to adverse cardiovascular outcomes. AREAS COVERED We searched MEDLINE up to April 2023 for umbrella reviews, (network-)meta-analyses, trials and cohort studies on risk factors, prevention and treatment strategies of weight gain associated with antidepressants/antipsychotics. We developed 10 clinical recommendations. EXPERT OPINION To prevent, manage, and treat antidepressant/antipsychotic-related weight gain, we recommend i) assessing risk factors for obesity before treatment, ii) monitoring metabolic health at baseline and regularly during follow-up, iii) offering lifestyle interventions including regular exercise and healthy diet based on patient preference to optimize motivation, iv) considering first-line psychotherapy for mild-moderate depression and anxiety disorders, v)choosing medications based on medications' and patient's weight gain risk, vi) choosing medications based on acute vs long-term treatment, vii) using effective, tolerated medications, viii) switching to less weight-inducing antipsychotics/antidepressants where possible, ix) using early weight gain as a predictor of further weight gain to inform the timing of intervention/switch options, and x) considering adding metformin or glucagon-like peptide-1 receptor agonists, or topiramate(second-line due to potential adverse cognitive effects) to antipsychotics, or aripiprazole to clozapine or olanzapine.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | - Federico Capone
- Department of Medicine (DIMED), Unit of Internal Medicine III, Padua University Hospital, University of Padua, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
- Physical and Mental Health Research Stream, Queensland Centre for Mental Health Research, School of Clinical Medicine, Brisbane, Qld, Australia
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Olivier Corbeil
- Faculty of Pharmacy, Université Laval, Québec, Canada
- Department of Pharmacy, Quebec Mental Health University Institute, Québec, Canada
| | - Samuele Cortese
- Developmental EPI (Evidence synthesis, Prediction, Implementation) lab, Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Child and Adolescent Mental Health Service, Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari 'Aldo Moro', Bari, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Glostrup, Denmark
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach and Support in South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven, Belgium
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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DelBello MP, Findling RL, Huss M, Necking O, Petersen ML, Schmidt SN, Rosen M. Vortioxetine in children and adolescents with major depressive disorder: 6-month and 18-month open-label, flexible-dose, long-term extension studies. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02560-1. [PMID: 39240359 DOI: 10.1007/s00787-024-02560-1] [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: 10/03/2023] [Accepted: 08/07/2024] [Indexed: 09/07/2024]
Abstract
Children and adolescents with severe or relapsing major depressive disorder (MDD) may require long-term antidepressant use, but safety and tolerability data on long-term treatment are limited. In a randomized, placebo-controlled trial in children and another in adolescents, vortioxetine and placebo groups showed improvement in MDD symptoms without statistically significant differences between groups. To gain insights on long-term safety and tolerability of vortioxetine in pediatric patients, participants from these two studies were enrolled in two long-term extension studies: 6 months (NCT02871297) followed by another 18 months (NCT03108625). Key safety measures included adverse events (AEs) and Columbia-Suicide Severity Rating Scale (C-SSRS); effectiveness measures included depression symptom severity, cognitive function, and overall functioning. Among the 662 patients in the 6-month extension, 61% experienced a treatment-emergent AE (TEAE), with the most common being nausea (20.8%); 2.1% had a serious AE (SAE), and 6% withdrew because of TEAEs. In the following 18-month extension (n = 94), 51% of patients experienced a TEAE, with the most common being headache (13.8%); no SAEs were reported. Based on the C-SSRS, 94% and 96% of patients reported no suicidal ideation or behavior in the 6- and 18-month studies, respectively. During the extension studies, patients continued to show improvement in depressive symptoms and cognitive and overall functioning, with > 50% of patients in remission at the end of each study, regardless of study treatment in the lead-in trial. Overall, vortioxetine remained well tolerated in pediatric patients with MDD who continued in the long-term extension studies with no observed increased risk in suicidal ideation.
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Affiliation(s)
- Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Ave. Suite 3200, Cincinnati, Ohio, 45219, USA.
| | - Robert L Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Huss
- Department of Child and Adolescent Psychiatry, University Medicine of Gutenberg University, Mainz, Germany
| | - Oscar Necking
- Clinical Research, H. Lundbeck A/S, Copenhagen, Denmark
| | | | | | - Monika Rosen
- Clinical Research, H. Lundbeck A/S, Copenhagen, Denmark
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Stuart S, Schultz J, Molina AP, Siber-Sanderowitz S. Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy. Psychodyn Psychiatry 2024; 52:370-407. [PMID: 39254940 DOI: 10.1521/pdps.2024.52.3.370] [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] [Indexed: 09/11/2024]
Abstract
Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"-that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities.
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Affiliation(s)
- Scott Stuart
- Director, IPT Institute; Adjunct Professor, University of Southern California, Department of Psychiatry; Professor Emeritus, University of Iowa Department of Psychiatry
| | - Jessica Schultz
- Associate Professor of Psychology, Augustana College, Rock Island, Illinois
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Weiss MD, Daniolos PT, Coughlin K, Mulvaney-Day N, Cook B, Rosenblum D. A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth. J Child Adolesc Psychopharmacol 2024; 34:292-301. [PMID: 38957953 DOI: 10.1089/cap.2023.0058] [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] [Indexed: 07/04/2024]
Abstract
Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.
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Affiliation(s)
- Margaret Danielle Weiss
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Peter T Daniolos
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Kevin Coughlin
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Benjamin Cook
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Debra Rosenblum
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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9
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Li R, Cicalese A, Whitney E. Mirtazapine as a Treatment for Adolescent Depression and PTSD in Juvenile Detention Settings: A Case Report. J Clin Psychopharmacol 2024:00004714-990000000-00288. [PMID: 39190765 DOI: 10.1097/jcp.0000000000001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
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10
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Yang JH, Park CHK, Rhee SJ, Kang DH, Kim MJ, Lee HJ, Lee SY, Shim SH, Moon JJ, Cho SJ, Kim SG, Kim MH, Lee J, Kang WS, Yoo J, Lee WY, Ahn YM. Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study. J Korean Med Sci 2024; 39:e226. [PMID: 39137811 PMCID: PMC11319105 DOI: 10.3346/jkms.2024.39.e226] [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: 03/06/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.
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Affiliation(s)
- Jeong Hun Yang
- Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Dae Hun Kang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jeong Lee
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, Cheonan, Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won Sub Kang
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Jieun Yoo
- College of Social Sciences, Yonsei University, Seoul, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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11
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Torralba-Suarez C, Olry-de-Labry-Lima A. An Umbrella Review of Cognitive Behavioural and Dialectical Behavioural Therapies to Treat Self-Harm and Suicidal Behaviour in Adolescents. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:549-560. [PMID: 39129696 PMCID: PMC11319749 DOI: 10.62641/aep.v52i4.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND The incidence of self-harm and suicidal behaviour in adolescents is increasing. Considering the great impact in this population, an actualization of the evidence of those psychological treatment's excellence for suicidal behaviour. Thus, the aim of this paper is to compile the available evidence on the effectiveness of cognitive behavioural therapy and dialectical behavioural therapy in preventing self-harm and suicidal behaviour in adolescents. METHODS A umbrella review was carried out, different databases (PubMed, CINAHL, Cochrane Library, Psyinfo, Embase, Web of Science, Scopus and Google Scholar) were consulted. The 16-item measurement tool to assess systematic reviews-2 (AMSTAR-2) were performed by two independent reviewers and any discrepancies were resolved by consensus. The Rayyan-Qatar Computing Research Institute was used for the screening process. RESULTS Nine systematic reviews were included. Cognitive Behavioural Therapy appears to reduce the incidence of suicide-related events compared with treatment as usual, compared to usual treatment (which usually consists of drugs and talk therapy) especially when combined with fluoxetine. Dialectical behavioural therapy seems to be associated with a reduction in suicidal ideation and self-harm. CONCLUSIONS Although the results found show results with high heterogeneity. The evidence on cognitive behavioural therapy and dialectical behavioural therapy for suicide prevention, self-harm and suicide ideation in adolescents seems to show positive results. Considering, the special population and great impact, further research is needed and comparable studies should be sought that allow to set up robust recommendations.
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Affiliation(s)
- Carla Torralba-Suarez
- Servicio de Medicina Preventiva del Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Antonio Olry-de-Labry-Lima
- Centro Andaluz de Documentación e Información de Medicamentos (CADIME), Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, 18080 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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12
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Koenig J, Vöckel J. Transcutaneous Auricular Vagus Nerve Stimulation in Adolescent Treatment Resistant Depression-A Case Report. J Pediatr 2024; 271:114078. [PMID: 38685314 DOI: 10.1016/j.jpeds.2024.114078] [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: 01/29/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Adolescence is a critical time period for the onset of depression, and many patients do not respond to treatment. Transcutaneous auricular vagus nerve stimulation may be a promising alternative. Here, we present the case of an adolescent girl with treatment-resistant depression who received transcutaneous auricular vagus nerve stimulation over the course of 7.5 months.
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Affiliation(s)
- Julian Koenig
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.
| | - Jasper Vöckel
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
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13
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Ampuero E, Luarte A, Flores FS, Soto AI, Pino C, Silva V, Erlandsen M, Concha T, Wyneken U. The multifaceted effects of fluoxetine treatment on cognitive functions. Front Pharmacol 2024; 15:1412420. [PMID: 39081952 PMCID: PMC11286485 DOI: 10.3389/fphar.2024.1412420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/10/2024] [Indexed: 08/02/2024] Open
Abstract
Fluoxetine, the prototypical selective serotonin reuptake inhibitor (SSRI), is widely used to treat major depressive disorder (MDD) and a variety of other central nervous system conditions, primarily due to its established clinical safety profile. Although its efficacy in treating depression is well-recognized, the impact of fluoxetine on cognitive functions remains inconsistent and elusive. In this review, we first examine the well-substantiated biological mechanisms underlying fluoxetine's antidepressant effects, which include serotonin reuptake inhibition and activation of TrkB receptors-key to brain-derived neurotrophic factor (BDNF) signaling. Subsequently, we delve into the cognitive side effects observed in both preclinical and clinical studies, affecting domains such as memory, attention, and executive functions. While certain studies indicate cognitive improvements in patients with underlying disorders, there is also evidence of negative effects, influenced by variables like gender, duration of treatment, age, disease pathology, and the specifics of cognitive testing. Significantly, the negative cognitive outcomes reported in preclinical research often involve healthy, non-diseased animals. This review underscores the necessity for heightened caution in fluoxetine prescription and further investigation into its potentially detrimental cognitive effects, even when used prophylactically.
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Affiliation(s)
- Estíbaliz Ampuero
- Laboratorio Neurofarmacología del Comportamiento, Facultad de Química y Biología, Universidad de Santiago, Santiago, Chile
| | - Alejandro Luarte
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Francisca Sofia Flores
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Antonia Ignacia Soto
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Catalina Pino
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Viviana Silva
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Macarena Erlandsen
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Teresita Concha
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Ursula Wyneken
- Laboratorio Neurociencias, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
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14
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Conway AE, Verdi M, Shaker MS, Bernstein JA, Beamish CC, Morse R, Madan J, Lee MW, Sussman G, Al-Nimr A, Hand M, Albert DA. Beyond Confirmed Mast Cell Activation Syndrome: Approaching Patients With Dysautonomia and Related Conditions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1738-1750. [PMID: 38499084 DOI: 10.1016/j.jaip.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/23/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
Allergist-immunologists face significant challenges as experts in an ever-evolving field of neuroimmunology. Among these challenges is the increasingly frequent need to counsel patients with suspected mast cell activation disorders about perceived comorbidities, which may include hypermobile Ehlers-Danlos syndrome, amplified pain syndrome, fibromyalgia, burning sensation syndromes, migraines, irritable bowel syndrome, and postural orthostatic tachycardia syndrome. Patients may experience comorbid anxiety, panic disorder, and depression associated with disturbed sleep, fatigue, and cognitive impairment that often worsen when their physical symptoms increase in severity. These conditions may mimic mast cell activation disorders and are emotionally taxing for patients and clinicians because they are often accompanied by vague diagnostic courses, perceived unmanageability, social stigma, and significant impairment in quality of life. Combined with relatively poorly researched therapies, it is no surprise that clinicians may feel overwhelmed or find it difficult to provide consistently compassionate care for this population. In this article, we review available therapies for these conditions, which run the gamut from physical therapy to antidepressants to multimodal pain control. We highlight the benefit of multidisciplinary care within the primary care home, which includes an important role by the allergist-immunologist. By outlining simple approaches to initial treatment, we hope to empower clinicians with the tools needed to curb emotional burnout and embrace this patient population with compassion.
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Affiliation(s)
| | | | - Marcus S Shaker
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Claire C Beamish
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard Morse
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Neurology, Children's Hospital at Dartmouth, Lebanon, NH
| | - Juliette Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Division of Child Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Psychiatry, Division of Child Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Michael W Lee
- Department of Medical Education, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Gordon Sussman
- Division of Immunology, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amer Al-Nimr
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew Hand
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Nephrology and Integrative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Daniel A Albert
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Rheumatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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15
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Giosan C, Pană A, Cosmoiu A, Chira AM, Toma AM, Papasteri CC, Nedelcea C, Popoviciu C. Mental health literacy and academic performance (MHLAP) in high school students: a randomized clinical trial protocol. Trials 2024; 25:419. [PMID: 38937769 PMCID: PMC11212191 DOI: 10.1186/s13063-024-08270-y] [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: 03/31/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Mental health literacy is a promising avenue of intervention for addressing the development of psychopathology, as well as its associated consequences, such as a decrease in academic performance. The current study aims to test the effectiveness of such an intervention in high school students, focusing on two main formats of delivery: (1) automated and (2) blended. METHODS To achieve this aim, a randomized clinical trial with direct comparisons at three time points between three conditions (automated, blended, and waitlist) was designed. Power analyses yielded a necessary sample size of 264 high school students. The participants will be selected from Romanian high schools. DISCUSSION The current study aims to contribute to the mental health literacy literature by testing the effectiveness of an educational intervention concerning mental health in terms of its benefits for reducing psychopathology and increasing academic performance. The success of such an intervention bears important implications for addressing mental health in the educational system. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT06217744, version 1, 22 January 2024.
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16
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Lou F, Luo S, Kang N, Yan L, Long H, Yang L, Wang H, Liu Y, Pu J, Xie P, Ji P, Jin X. Oral microbiota dysbiosis alters chronic restraint stress-induced depression-like behaviors by modulating host metabolism. Pharmacol Res 2024; 204:107214. [PMID: 38763328 DOI: 10.1016/j.phrs.2024.107214] [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: 01/27/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Studies have shown that the microbiota-gut-brain axis is highly correlated with the pathogenesis of depression in humans. However, whether independent oral microbiome that do not depend on gut microbes could affect the progression of depression in human beings remains unclear, neither does the presence and underlying mechanisms of the microbiota-oral-brain axis in the development of the condition. Hence this study that encompasses clinical and animal experiments aims at investigating the correlation between oral microbiota and the onset of depression via mediating the microbiota-oral-brain axis. We compared the oral microbial compositions and metabolomes of 87 patients with depressive symptoms versus 70 healthy controls. We found that the oral microbial and metabolic signatures were significantly different between the two groups. Significantly, germ-free (GF) mice transplanted with saliva from mice exposing to chronic restraint stress (CRS) displayed depression-like behavior and oral microbial dysbiosis. This was characterized by a significant differential abundance of bacterial species, including the enrichment of Pseudomonas, Pasteurellaceae, and Muribacter, as well as the depletion of Streptococcus. Metabolomic analysis showed the alternation of metabolites in the plasma of CRS-exposed GF mice, especially Eicosapentaenoic Acid. Furthermore, oral and gut barrier dysfunction caused by CRS-induced oral microbiota dysbiosis may be associated with increased blood-brain barrier permeability. Pseudomonas aeruginosa supplementation exacerbated depression-like behavior, while Eicosapentaenoic Acid treatment conferred protection against depression-like states in mice. These results suggest that oral microbiome and metabolic function dysbiosis may be relevant to the pathogenesis and pathophysiology of depression. The proposed microbiota-oral-brain axis provides a new way and targets for us to study the pathogenesis of depression.
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Affiliation(s)
- Fangzhi Lou
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China
| | - Shihong Luo
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Ning Kang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China
| | - Li Yan
- College of Medical Informatics, Chongqing Medical University, Chongqing 400016, China
| | - Huiqing Long
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China
| | - Lu Yang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China
| | - Haiyang Wang
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Yiyun Liu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Juncai Pu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China
| | - Xin Jin
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases, Chongqing 401147, China.
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17
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Smárason O, Skarphedinsson G, Storch EA. Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents. Psychiatr Clin North Am 2024; 47:311-323. [PMID: 38724122 DOI: 10.1016/j.psc.2024.02.002] [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] [Indexed: 07/10/2024]
Abstract
Anxiety and depression are prevalent and impairing psychiatric problems for children and adolescents. In this review, the authors summarize information about their prevalence and impact, the most common assessment methods, the main components of cognitive behavioral therapy (CBT), and research on the effectiveness of CBT for these disorders. Future directions, including improving access to CBT through technology-based approaches and increasing personalization of treatment, are discussed.
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Affiliation(s)
- Orri Smárason
- Department of Child and Adolescent Psychiatry, Landspitali - The National University Hospital of Iceland, Dalbraut 12 105, Reykjavik.
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
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18
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Bruton AM, Wesemann DG, Machingo TA, Majak G, Johnstone JM, Marshall RD. Ketamine for mood disorders, anxiety, and suicidality in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02458-y. [PMID: 38750191 DOI: 10.1007/s00787-024-02458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/29/2024] [Indexed: 07/13/2024]
Abstract
Mood disorders, anxiety, and suicidality in youth are increasing and rapid-acting treatments are urgently needed. One potential is ketamine or its enantiomer esketamine, which was FDA approved in 2019 to treat major depressive disorder with suicidality in adults. This systematic review evaluated the evidence for the clinical use of ketamine to treat mood disorders, anxiety, and suicidality in youth. The PRISMA guidelines were used, and a protocol registered prospectively ( https://osf.io/9ucsg/ ). The literature search included Pubmed/MEDLINE, Ovid/MEDLINE, Scopus, CINAHL, PsychInfo, and Google Scholar. Trial registries and preprint servers were searched, and authors contacted for clarification. Studies reported on the clinical use of ketamine to treat anxiety, depression, bipolar disorder, or suicidality in youth ≤19 years old and assessed symptoms before and after ketamine use. Study screening and data extraction were conducted independently by 2-4 authors. Safety, tolerability, and efficacy data were collected. The Cochrane Risk of Bias guidelines assessed the quality of the evidence. Twenty-two published reports based on 16 studies were identified: 7 case studies, 6 observational studies, 3 randomized trials, and 6 secondary data analyses. Studies reported immediate improvements in depression, anxiety, and suicidality. Improvements were maintained for weeks-months following treatment. Ketamine was well-tolerated with the most common side effects being dizziness, nausea, and mild dissociation. Transient hemodynamic changes were reported, all of which resolved quickly and did not require medical intervention. Initial evidence suggests ketamine is safe and may be effective for mood disorders, anxiety, and suicidality in youth. Further randomized trials are warranted.
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Affiliation(s)
| | | | | | - Gop Majak
- University of Lethbridge, Lethbridge, Canada
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19
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Zhao M, Ren Z, Zhao A, Tang Y, Kuang J, Li M, Chen T, Wang S, Wang J, Zhang H, Wang J, Zhang T, Zeng J, Liu X, Xie G, Liu P, Sun N, Bao T, Nie T, Lin J, Liu P, Zheng Y, Zheng X, Liu T, Jia W. Gut bacteria-driven homovanillic acid alleviates depression by modulating synaptic integrity. Cell Metab 2024; 36:1000-1012.e6. [PMID: 38582087 DOI: 10.1016/j.cmet.2024.03.010] [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: 07/06/2023] [Revised: 12/04/2023] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
The gut-brain axis is implicated in depression development, yet its underlying mechanism remains unclear. We observed depleted gut bacterial species, including Bifidobacterium longum and Roseburia intestinalis, and the neurotransmitter homovanillic acid (HVA) in individuals with depression and mouse depression models. Although R. intestinalis does not directly produce HVA, it enhances B. longum abundance, leading to HVA generation. This highlights a synergistic interaction among gut microbiota in regulating intestinal neurotransmitter production. Administering HVA, B. longum, or R. intestinalis to mouse models with chronic unpredictable mild stress (CUMS) and corticosterone (CORT)-induced depression significantly improved depressive symptoms. Mechanistically, HVA inhibited synaptic autophagic death by preventing excessive degradation of microtubule-associated protein 1 light chain 3 (LC3) and SQSTM1/p62 proteins, protecting hippocampal neurons' presynaptic membrane. These findings underscore the role of the gut microbial metabolism in modulating synaptic integrity and provide insights into potential novel treatment strategies for depression.
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Affiliation(s)
- Mingliang Zhao
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhenxing Ren
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Aihua Zhao
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yajun Tang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Junliang Kuang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Mengci Li
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Tianlu Chen
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shouli Wang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jieyi Wang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Huiheng Zhang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Tianhong Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Jiahui Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Xiaohua Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Guoxiang Xie
- Human Metabolomics Institute, Inc., Shenzhen 518109, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Tianhao Bao
- The Affiliated Mental Health Center of Kunming Medical University, Kunming 650224, China
| | - Tongtong Nie
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Jingchao Lin
- Human Metabolomics Institute, Inc., Shenzhen 518109, China
| | - Ping Liu
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Xiaojiao Zheng
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China.
| | - Tiemin Liu
- State Key Laboratory of Genetic Engineering, Department of Endocrinology and Metabolism, Institute of Metabolism and Integrative Biology, Human Phenome Institute, and School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai 200438, China.
| | - Wei Jia
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China.
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20
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Ekbäck E, Rådmark L, Molin J, Strömbäck M, Midgley N, Henje E. The Power Threat Meaning Framework: a qualitative study of depression in adolescents and young adults. Front Psychiatry 2024; 15:1393066. [PMID: 38757135 PMCID: PMC11097657 DOI: 10.3389/fpsyt.2024.1393066] [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: 02/28/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Depression constitutes one of our largest global health concerns and current treatment strategies lack convincing evidence of effectiveness in youth. We suggest that this is partly due to inherent limitations of the present diagnostic paradigm that may group fundamentally different conditions together without sufficient consideration of etiology, developmental aspects, or context. Alternatives that complement the diagnostic system are available yet understudied. The Power Threat and Meaning Framework (PTMF) is one option, developed for explanatory and practical purposes. While based on scientific evidence, empirical research on the framework itself is still lacking. This qualitative study was performed to explore the experiences of adolescents and young adults with depression from the perspective of the PTMF. Methods We conducted semi-structured interviews with 11 Swedish individuals aged 15- 22 years, mainly female, currently enrolled in a clinical trial for major depressive disorder. Interviews were transcribed verbatim and analyzed with framework analysis informed by the PTMF. Results A complex multitude of adversities preceding the onset of depression was described, with a rich variety of effects, interpretations, and reactions. In total, 17 themes were identified in the four dimensions of the PTMF, highlighting the explanatory power of the framework in this context. Not all participants were able to formulate coherent narratives. Discussion The PTMF provides a framework for understanding the complexities, common themes, and lived experiences of young individuals with depression. This may be essential for the development of new interventions with increased precision and effectiveness in the young.
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Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Lina Rådmark
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Jenny Molin
- Department of Clinical Science, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Nick Midgley
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
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21
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Guo J, Zhang T, Chen W, Tan J, Li X, Zheng A, Fu Y, Qiu T. The relationship between serum resolvin D1, NLRP3, cytokine levels, and adolescents with first-episode medication-naïve major depressive disorder. BMC Psychiatry 2024; 24:285. [PMID: 38627683 PMCID: PMC11020182 DOI: 10.1186/s12888-024-05724-0] [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: 03/07/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Inflammation has become a critical pathological mechanism of Major Depressive Disorder (MDD). NLRP3 is a critical inflammatory pathway to maintain the immune balance. Recently, preclinical evidence showed that Resolvin D1 might potentially offer a new option for antidepressant treatment due to its protective effects through the inhibition of neuroinflammation. However, whether they have clinical value in the diagnosis and treatment evaluation of adolescent depression was unclear. METHODS Forty-eight untreated first-episode adolescent patients with moderate to severe major depressive disorder, as well as 30 healthy adolescents (HCs, age and gender-matched), were enrolled for this study. Their ages ranged from 13 to 18 (15.75 ± 1.36) years. The patients were treated with fluoxetine for 6-8 weeks. HDRS-17 was used to evaluate the severity of depressive symptoms. Venous blood samples were collected at baseline for the two groups and at the time-point of post-antidepressant treatment for the patients. Serum concentrations of RvD1, NLRP3, IL-1β, IL-18, and IL-4 were measured by enzyme-linked immunosorbent assays (ELISA) pre- and post-fluoxetine treatment. RESULTS Serum levels of RvD1 and anti-inflammatory cytokine IL-4 were significantly elevated in adolescents with MDD compared to healthy adolescents, but no significant difference in NLRP3, IL-1β, and IL-18 between the two groups. Meanwhile, RvD1 (positively) and IL-4 (negatively) were correlated with the severity of symptoms (HDRS-17 scores) after adjusting age, gender, and BMI. Interestingly, fluoxetine treatment significantly reduced the serum levels of RvD1, NLRP3, IL-1β, and IL-18 in MDD adolescents but increased the levels of IL-4 relative to baseline. Furthermore, we observed that serum levels of RvD1 might be an excellent distinguishing indicator for depression and healthy adolescents. CONCLUSIONS Our study is the first to compare RvD1 and NLRP3 between adolescent MDD and HCs. Our findings of reactive increase of RvD1 in adolescent MDD comprised a novel and critical contribution. Our results showed the presence of inflammation resolution unbalanced in adolescents with MDD and indicated that RvD1 might be an ideal biomarker for diagnosing and treating adolescent MDD.
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Affiliation(s)
- Jiamei Guo
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Tanwei Zhang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Wanjun Chen
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Jianyu Tan
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Xiao Li
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Anhai Zheng
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Yixiao Fu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China
| | - Tian Qiu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, P.R. China.
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Cortese S, Besag FMC, Clark B, Hollis C, Kilgariff J, Moreno C, Nicholls D, Wilkinson P, Woodbury-Smith M, Sharma A. Common pitfalls, and how to avoid them, in child and adolescent psychopharmacology: Part I. J Psychopharmacol 2024; 38:311-317. [PMID: 38494948 PMCID: PMC11010544 DOI: 10.1177/02698811241239582] [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] [Indexed: 03/19/2024]
Abstract
As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of attention-deficit/hyperactivity disorder, anxiety, bipolar disorder, depression, obsessive-compulsive disorder and related disorders, and tic disorder. Pitfalls in the treatment of other disorders are addressed in a separate paper (part II).
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Frank MC Besag
- UCL School of Pharmacy, London, UK
- East London Foundation NHS Trust, Bedfordshire, UK
| | - Bruce Clark
- National Specialist Clinic for Young People with OCD, BDD and Related Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Hollis
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
- National Institute of Mental Health (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health & Technology Theme, Institute of Mental Health, Nottingham, UK
| | - Joe Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
- NIHR ARC Northwest London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Aditya Sharma
- Academic Psychiatry, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Specialist Adolescent Mood Disorders Service (SAMS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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23
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Chen R, Guo Y, Kuang Y, Zhang Q. Effects of home-based exercise interventions on post-stroke depression: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 152:104698. [PMID: 38290424 DOI: 10.1016/j.ijnurstu.2024.104698] [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: 04/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Post-stroke depression (PSD) is a common and persistent mental disorder that negatively impacts stroke outcomes. Exercise-based interventions have been shown to be an effective non-pharmacological treatment for improving depression in patients with mild stroke, but no reviews have yet synthesized the effects of home-based exercise on PSD. OBJECTIVE The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare the effectiveness of different types of home-based exercise programs on PSD and identify the optimal home-based exercise modality to inform clinical decision-making for the treatment of PSD. METHODS PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO were systematically searched from their inception dates to March 7, 2023. We searched for randomized controlled trials (RCTs) of home-based exercise for PSD in adults aged 18 years and older. Only scores of depression retrieved directly post-treatment were included as the primary endpoint for the analysis. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the quality of included studies. We conducted traditional pairwise meta-analysis for direct comparisons using Review Manager 5.4.1, followed by network meta-analysis using Stata 15.1 for both the network evidence plot and analysis. The surface under the cumulative ranking curve (SUCRA) was used to estimate the intervention hierarchy. The protocol was registered with PROSPERO under registration number CRD42022363784. RESULTS A total of 517 participants from nine RCTs were included. Based on the ranking probabilities, mind-body exercise was the most effective way in improving PSD (SUCRA: 90.4 %, Hedges' g: -0.59, 95 % confidence interval [CI]: -1.16 to -0.02), followed by flexibility/neuro-motor skills training (SUCRA: 42.9 %, Hedges' g: -0.10, 95 % CI: -0.70 to 0.49), and aerobic exercise (SUCRA: 39.3 %, Hedges' g: -0.07, 95 % CI: -0.81 to 0.67). We performed a subgroup analysis of mind-body exercise. In mind-body exercise interventions, Tai Chi was the most effective way to improve PSD (SUCRA: 99.4 %, Hedges' g: -0.94, 95 % CI: -1.28 to -0.61). CONCLUSIONS Our network meta-analysis that provides evidence with very low certainty indicates potential benefits of home-based exercise for alleviating PSD, with mind-body exercises, notably Tai Chi, showing promise as an effective treatment. However, further rigorous studies are needed to solidify these findings. Specifically, multicenter RCTs comparing specific exercises to no intervention are crucial, assessing not only efficacy but also dose, reach, fidelity, and long-term effects for real-world optimization.
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Affiliation(s)
- Rong Chen
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Yijia Guo
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Yashi Kuang
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Qi Zhang
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China.
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24
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Jureidini J, Moncrieff J, Klau J, Aboustate N, Raven M. Treatment guesses in the Treatment for Adolescents with Depression Study: Accuracy, unblinding and influence on outcomes. Aust N Z J Psychiatry 2024; 58:355-364. [PMID: 38126083 PMCID: PMC10960316 DOI: 10.1177/00048674231218623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We evaluated the presence and impact of unblinding during the influential Treatment for Adolescents with Depression Study (ClinicalTrials.gov Identifier: NCT00006286). METHOD Our analysis was part of a Restoring Invisible and Abandoned Trials reanalysis. Treatment for Adolescents with Depression Study trialled fluoxetine, placebo, cognitive behaviour therapy or their combination, in treating adolescents with major depressive disorder. We analysed the accuracy of guesses of fluoxetine or placebo allocation, and their effects on change in Children's Depression Rating Scale-Revised at 12 weeks. RESULTS Of 221 participants allocated to fluoxetine or placebo, 151 adolescents (68%) had their guess about pill-treatment-arm allocation recorded at week 6, and guesses were recorded for 154 independent evaluators, 159 parents and 164 pharmacotherapists. All of these groups guessed treatment allocation more accurately than would be expected by chance (60-66% accuracy; all p-values ⩽ 0.004). Guesses did not become more accurate between 6 and 12 weeks and were not predicted by adverse events, though event documentation was poor. Treatment guess had a substantial and statistically significant effect on outcome (Children's Depression Rating Scale-Revised change mean difference 9.12 [4.69; 13.55], β = 0.334, p < 0.001), but actual treatment arm did not (1.53 [-2.83; 5.89], β = 0.056, p = 0.489). Removing guess from the analysis increased the apparent effect of treatment arm, making it almost statistically significant at the conventional alpha-level of 0.05 (p = 0.06). CONCLUSIONS For Treatment for Adolescents with Depression Study, treatment guesses strongly predicted outcomes and may have led to the exaggeration of drug effectiveness in the absence of actual effects. The integrity of double-blinding in trials should be routinely assessed and reported.
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Affiliation(s)
- Jon Jureidini
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Joanna Moncrieff
- Division of Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Julie Klau
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Natalie Aboustate
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa Raven
- Critical and Ethical Mental Health Research Group, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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25
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Liu H, Hao Z, Qiu S, Wang Q, Zhan L, Huang L, Shao Y, Wang Q, Su C, Cao Y, Sun J, Wang C, Lv Y, Li M, Shen W, Li H, Jia X. Grey matter structural alterations in anxiety disorders: a voxel-based meta-analysis. Brain Imaging Behav 2024; 18:456-474. [PMID: 38150133 DOI: 10.1007/s11682-023-00842-x] [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] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Anxiety disorders (ADs) are a group of prevalent and destructive mental illnesses, but the current understanding of their underlying neuropathology is still unclear. Employing voxel-based morphometry (VBM), previous studies have demonstrated several common brain regions showing grey matter volume (GMV) abnormalities. However, contradictory results have been reported among these studies. Considering that different subtypes of ADs exhibit common core symptoms despite different diagnostic criteria, and previous meta-analyses have found common core GMV-altered brain regions in ADs, the present research aimed to combine the results of individual studies to identify common GMV abnormalities in ADs. Therefore, we first performed a systematic search in PubMed, Embase, and Web of Science on studies investigating GMV differences between patients with ADs and healthy controls (HCs). Then, the anisotropic effect-size signed differential mapping (AES-SDM) was applied in this meta-analysis. A total of 24 studies (including 25 data sets) were included in the current study, and 906 patients with ADs and 1003 HCs were included. Compared with the HCs, the patients with ADs showed increased GMV in the left superior parietal gyrus, right angular gyrus, left precentral gyrus, and right lingual gyrus, and decreased GMV in the bilateral insula, bilateral thalamus, left caudate, and right putamen. In conclusion, the current study has identified some abnormal GMV brain regions that are related to the pathological mechanisms of anxiety disorders. These findings could contribute to a better understanding of the underlying neuropathology of ADs.
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Affiliation(s)
- Han Liu
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Zeqi Hao
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Shasha Qiu
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Qianqian Wang
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Linlin Zhan
- School of Western Languages, Heilongjiang University, Heilongjiang, China
| | - Lina Huang
- Department of Radiology, Changshu No.2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Youbin Shao
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Qing Wang
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Chang Su
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Yikang Cao
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Jiawei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Chunjie Wang
- Institute of Brain Science, Department of Psychology, School of Education, Hangzhou Normal University, Hangzhou, China
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Yating Lv
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Mengting Li
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China
| | - Wenbin Shen
- Department of Radiology, Changshu No.2 People's Hospital, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Huayun Li
- School of Psychology, Zhejiang Normal University, Jinhua, China.
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China.
| | - Xize Jia
- School of Psychology, Zhejiang Normal University, Jinhua, China.
- Intelligent Laboratory of Zhejiang Province in Mental Health and Crisis Intervention for Children and Adolescents, Zhejiang Normal University, Jinhua, China.
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26
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Chen H, Zhou M, Han L, Manoharasetty A, Yu Z, Luo H. Efficacy and executive function of solution-focused brief therapy on adolescent depression. Front Psychiatry 2024; 15:1246986. [PMID: 38525259 PMCID: PMC10957764 DOI: 10.3389/fpsyt.2024.1246986] [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: 06/26/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To investigate the efficacy and impact on executive function of Solution-Focused Brief Therapy (SFBT) in treating Major Depressive Disorder (MDD) in adolescents. Methods A total of 129 adolescents diagnosed with MDD were enrolled in the study. Out of these, 28 adolescents were assigned to the SFBT group, while 25 were part of the Active Control group (AC group), receiving psychodynamic psychotherapy. Executive function, depressive and anxiety symptoms were assessed at baseline, at the time of the third intervention, the sixth intervention, and the 10th intervention. Results After the third intervention, the scores of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) of the participants in the SFBT group decreased significantly, which had the cumulative effect at the 6th and 10th interventions. The verbal fluency task (VFT) performances of the SFBT group participants yielded significantly higher scores after the third intervention and remained increasing at the 6th and 10th interventions. The AC group steadily decreased after the intervention. Analysis of functional near-infrared spectroscopy (fNIRS) data revealed a progressive and significant increase in the average oxyhemoglobin (oxy-Hb) levels in the dorsolateral prefrontal cortex (DLPFC) in the SFBT group compared to the AC group after the 10th intervention. Conclusions SFBT might improve depressive and anxiety symptoms as well as executive function of adolescent depression. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR2300067909.
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Affiliation(s)
- Haisi Chen
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengmeng Zhou
- Internal Medicine Department, Hangzhou Linping District Maternal and Child Care Hospital, Hangzhou, China
| | - Li Han
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Advaith Manoharasetty
- Institute for International Education, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhenghe Yu
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Luo
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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27
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Ledesma-Corvi S, Jornet-Plaza J, Gálvez-Melero L, García-Fuster MJ. Novel rapid treatment options for adolescent depression. Pharmacol Res 2024; 201:107085. [PMID: 38309382 DOI: 10.1016/j.phrs.2024.107085] [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: 08/01/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
There is an urgent need for novel fast-acting antidepressants for adolescent treatment-resistant depression and/or suicidal risk, since the selective serotonin reuptake inhibitors that are clinically approved for that age (i.e., fluoxetine or escitalopram) take weeks to work. In this context, one of the main research lines of our group is to characterize at the preclinical level novel approaches for rapid-acting antidepressants for adolescence. The present review summarizes the potential use in adolescence of non-pharmacological options, such as neuromodulators (electroconvulsive therapy and other innovative types of brain stimulation), as well as pharmacological options, including consciousness-altering drugs (mainly ketamine but also classical psychedelics) and cannabinoids (i.e., cannabidiol), with promising fast-acting responses. Following a brief analytical explanation of adolescent depression, we present a general introduction for each therapeutical approach together with the clinical evidence supporting its potential beneficial use in adolescence (mainly extrapolated from prior successful examples for adults), to then report recent and/or ongoing preclinical studies that will aid in improving the inclusion of these therapies in the clinic, by considering potential sex-, age-, and dose-related differences, and/or other factors that might affect efficacy or long-term safety. Finally, we conclude the review by providing future avenues to maximize treatment response, including the need for more clinical studies and the importance of designing and/or testing novel treatment options that are safe and fast-acting for adolescent depression.
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Affiliation(s)
- Sandra Ledesma-Corvi
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jordi Jornet-Plaza
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Laura Gálvez-Melero
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - M Julia García-Fuster
- Neuropharmacology Research Group, IUNICS, University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Medicine, University of the Balearic Islands, Palma, Spain.
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Cheng YC, Chen WY, Su MI, Tu YK, Chiu CC, Huang WL. Efficacy of neuromodulation on the treatment of fibromyalgia: A network meta-analysis. Gen Hosp Psychiatry 2024; 87:103-123. [PMID: 38382420 DOI: 10.1016/j.genhosppsych.2024.01.007] [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: 11/10/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Several types of neuromodulation have been investigated for the treatment of fibromyalgia, but they show varied efficacy on pain, functioning, comorbid depression and comorbid anxiety. Whether some types of neuromodulation or some factors are associated with a better response also awaits clarification. METHODS We conducted a systematic review and network meta-analysis of randomized controlled trials to evaluate the efficacy of neuromodulation in patients with fibromyalgia. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and PsycINFO before March 2022. We employed a frequentist random-effects network meta-analysis. RESULTS Forty trials involving 1541 participants were included. Compared with sham control interventions, several types of transcranial direct current stimulation (tDCS), transcranial random noise stimulation (tRNS), and high-frequency repetitive transcranial magnetic stimulation (rTMS) were associated with significant reduction of pain, depression, anxiety, and improvement in functioning. Many significantly effective treatment options involve stimulation of the primary motor cortex or dorsolateral prefrontal cortex. CONCLUSION We concluded that several types of rTMS, tDCS and tRNS may have the potential to be applied for clinical purposes.
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Affiliation(s)
- Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yin Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Min-I Su
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan; Graduate Institute of Business Administration, College of Management, National Dong Hwa University, Hualien, Taiwan
| | - Yu-Kang Tu
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Cerebellar Research Center, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
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Loades ME, Midgley N, Herring GT, O'Keeffe S, Reynolds S, Goodyer IM. In Context: Lessons About Adolescent Unipolar Depression From the Improving Mood With Psychoanalytic and Cognitive Therapies Trial. J Am Acad Child Adolesc Psychiatry 2024; 63:122-135. [PMID: 37121393 DOI: 10.1016/j.jaac.2023.03.017] [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: 08/12/2022] [Revised: 02/19/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
This paper summarizes the results of the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) study and its implications for psychological treatment of adolescents with moderate to severe unipolar major depression. IMPACT was a pragmatic, superiority, randomized controlled trial conducted in the United Kingdom, which compared the clinical and cost-effectiveness of short-term psychoanalytic therapy (STPP), cognitive-behavioral therapy (CBT), and a brief psychosocial intervention (BPI) in reducing depression symptoms in 465 adolescents with unipolar major depression, aged 11 to 17 years. Although this was a clinically heterogeneous group of adolescents, some symptoms (eg, sleep and concentration difficulties, irritability/anger) were common and disabling. The trial reported no significant difference among the 3 treatments in reducing depression symptoms. One year after treatment, 84% of participants showed improvement in depressive symptoms (<50% of baseline symptoms) and improved psychosocial functioning, achieving this through different symptom reduction trajectories. Although participants attended fewer treatment sessions than planned, the 3 treatments were delivered with fidelity to their respective models. Ending treatment without therapist agreement occurred in 37% of cases. This was not associated with outcomes by treatment group. Adolescents emphasized the importance of the therapeutic relationship in all 3 treatments. Results suggest that although most adolescents respond to time-limited, structured psychological therapy, subgroups of depressed adolescents are likely to need additional treatment or support. These include adolescents who live in complex circumstances and/or who believe that their needs are not met in therapy, some who stop treatment early, and the 16% to 18% of adolescents who do not respond to treatment. CLINICAL TRIAL REGISTRATION INFORMATION: Improving Mood and Preventing Relapse With Psychoanalytic Psychotherapy and Cognitive Behaviour Therapy; https://www.isrctn.com; ISRCTN83033550.
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Affiliation(s)
| | - Nick Midgley
- University College London, United Kingdom and Anna Freud National Centre for Children and Families, London, United Kingdom.
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Sun L, Ma S, Yu Y, Li X, Wei Q, Min L, Rong P. Transcutaneous auricular vagus nerve stimulation ameliorates adolescent depressive- and anxiety-like behaviors via hippocampus glycolysis and inflammation response. CNS Neurosci Ther 2024; 30:e14614. [PMID: 38358062 PMCID: PMC10867795 DOI: 10.1111/cns.14614] [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: 10/24/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) is a crucial neuromodulation therapy for depression, yet its molecular mechanism remains unclear. Here, we aim to unveil the underlying mechanisms of antidepression by systematically evaluating the change of gene expression in different brain regions (i.e., hippocampus, anterior cingulate cortex, and medial prefrontal cortex). METHODS The adolescent depression rat model was established by chronic unpredictable mild stress (CUMS), followed by the taVNS treatment for 3 weeks. The open field test (OFT), forced swimming test (FST), elevated plus maze test (EPM), and new object recognition (NOR) test were used to evaluate depressive- and anxiety-like behaviors. Gene expression analysis of three brain regions was conducted by RNA sequencing (RNA-seq) and further bioinformatics methods. RESULTS The depressive- and anxiety-like behaviors in CUMS-exposed rats were manifested by decreased spontaneous locomotor activity of OFT, increased immobility time of FST, increased entries and time in the closed arms of EPM, and decreased new object index of NOR. Furthermore, CUMS exposure also led to alterations in gene expression within the hippocampus (HIP), anterior cingulate cortex (ACC), and medial prefrontal cortex (mPFC), suggesting a potential link between adolescent stress and pathological changes within these brain regions. TaVNS could significantly ameliorate depressive- and anxiety-like behaviors. Its effects on these three brain regions were found related to regulation of the metabolism, and there were some brain region-specific findings. Compared with ACC and mPFC, taVNS has a more concrete effect on HIP by regulating the inflammation response and glycolysis. CONCLUSION taVNS is capable of ameliorating adolescent depressive- and anxiety-like behaviors by regulating plenty of genes in the three brain regions. Suppressed level of inflammatory response and enhanced glycolysis manifests the dominant role of taVNS in HIP, which provides a theoretical foundation and data support for the molecular mechanism of antidepression by taVNS.
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Affiliation(s)
- Lan Sun
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical SciencesBeijingChina
| | - Shixiang Ma
- Department of Retroperitoneal Tumor SurgeryPeking University International HospitalBeijingChina
| | - Yun Yu
- School of Life Science and TechnologyXi'an Jiaotong UniversityXi'anChina
| | - Xiangji Li
- State Key Laboratory for Digestive Health, National Clinical Research Center for Digestive Diseases, Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Qianwen Wei
- School of Acupuncture‐Moxibustion and TuinaBeijing University of Chinese MedicineBeijingChina
| | - Li Min
- State Key Laboratory for Digestive Health, National Clinical Research Center for Digestive Diseases, Department of GastroenterologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical SciencesBeijingChina
- Institute of Basic Research in Clinical MedicineChina Academy of Chinese Medical SciencesBeijingChina
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31
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Storebø OJ, Ribeiro JP, Lunde C, Gluud C. WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents. Lancet Psychiatry 2024; 11:93. [PMID: 38245023 DOI: 10.1016/s2215-0366(23)00395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Ole Jakob Storebø
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Johanne Pereira Ribeiro
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Christian Gluud
- Department of Regional Health Research, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark; The Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Li J, Zhang K, Zhao T, Huang W, Hou R, Wang S, Zhao M, Guo Y. Acupressure for depression: A systematic review and meta-analysis. Asian J Psychiatr 2024; 92:103884. [PMID: 38171225 DOI: 10.1016/j.ajp.2023.103884] [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: 10/08/2023] [Revised: 11/22/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
Depression is a common mental disorder caused by the interaction of social, psychological, and biological factors. Treatments include psychotherapy, pharmacotherapy, and other therapies, but they have limitations. Particularly, the COVID-19 pandemic may have a negative impact on depressed people. Thus, developing more potential treatments for depression has currently been an urgent challenge. A growing number of studies have found that acupressure is effective in relieving the symptoms of depression. Thus, this study aimed to evaluate the efficacy and safety of acupressure in people with depression. English (PubMed, CENTRAL, EMBASE, APA PsycINFO, and CINAHL) and Chinese databases (CBM, CNKI, Wanfang, and VIP), ClinicalTrials.gov and Chinese Clinical Trial Registry were searched for randomized controlled trials (RCTs) on patients diagnosed with depression from study inception until March 31, 2023. Studies that compared acupressure with sham acupressure, conventional treatments (i.e., medication, usual care, etc.), and acupressure as an adjunct to conventional treatment for depression were included. The primary outcome was depression level measured using the Hamilton Depression Scale, Self-Rating Depression Scale, or Geriatric Depression Scale. A total of 19 RCTs involving 1686 participants were included. The pooled results showed that acupressure exhibited a significant beneficial effect on reducing the severity of depression compared with sham acupressure and served as an adjunct to conventional treatment, although the evidence level was moderate. Thus, acupressure may be a potential treatment for depression.
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Affiliation(s)
- Jiaqi Li
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Modern Chinese Medicine Theory of Innovation and Application, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Kai Zhang
- Department of Acupuncture and Moxibustion, Tianjin Gong An Hospital, Tianjin 300042, China
| | - Tianyi Zhao
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Wenjing Huang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Modern Chinese Medicine Theory of Innovation and Application, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Ruiling Hou
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Modern Chinese Medicine Theory of Innovation and Application, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Shenjun Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Modern Chinese Medicine Theory of Innovation and Application, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Meidan Zhao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Medical Technology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Modern Chinese Medicine Theory of Innovation and Application, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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Ballard R, Parkhurst JT, Gadek LK, Julian KM, Yang A, Pasetes LN, Goel N, Sit DK. Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study. Clocks Sleep 2024; 6:56-71. [PMID: 38390946 PMCID: PMC10885037 DOI: 10.3390/clockssleep6010005] [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: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings. METHODS We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables. RESULTS Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase. CONCLUSION Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.
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Affiliation(s)
- Rachel Ballard
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - John T Parkhurst
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Lisa K Gadek
- Lake Forest Pediatrics, Lake Bluff, IL 60044, USA
| | - Kelsey M Julian
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Amy Yang
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
| | - Lauren N Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
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Cuerda-Ballester M, Bustos A, Sancho-Cantus D, Martínez-Rubio D, Privado J, Alarcón-Jiménez J, Villarón-Casales C, de Bernardo N, Navarro Illana E, de la Rubia Ortí JE. Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment. Bioengineering (Basel) 2024; 11:100. [PMID: 38275580 PMCID: PMC10813122 DOI: 10.3390/bioengineering11010100] [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: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. AIM To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. MATERIALS AND METHODS A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). RESULTS The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (β = -0.83), followed by functional activity (β = -0.18) and prefrontal symptoms (β = 0.15). The latter two are negatively related to psychological well-being (β = -0.16 and β = -0.75, respectively). CONCLUSIONS Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.
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Affiliation(s)
| | - Antonio Bustos
- Physical Therapy Clinic, Antonio Bustos, 46007 Valencia, Spain;
| | - David Sancho-Cantus
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
| | - David Martínez-Rubio
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Department of Psychology, European University of Valencia, 46010 Valencia, Spain
| | - Jesús Privado
- Department of Methodology of Behavioral Sciences, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Jorge Alarcón-Jiménez
- Department of Physiotherapy, Universidad Católica de Valencia, 46900 Valencia, Spain;
| | - Carlos Villarón-Casales
- Biomechanics & Physiotherapy in Sports (BIOCAPS), Faculty of Health Sciences, European University of Valencia, 46001 Valencia, Spain;
| | - Nieves de Bernardo
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
| | - Esther Navarro Illana
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
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Hach I, Bertsch T, Nonell P. The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents. Front Psychiatry 2024; 14:1240681. [PMID: 38298931 PMCID: PMC10827976 DOI: 10.3389/fpsyt.2023.1240681] [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: 06/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Adolescents with mental disorders show an increased risk of suicidal phenomena. Vice versa, suicidality is a serious adverse event of psychotropic drug therapy in adolescents. There are only a few new psychotropic agents approved for this young age group. We evaluated the (pre-pandemic) prevalence of off-label use as well as detailed blood concentrations of outpatient psychotropic medication and sex differences in a clinical population of suicidal adolescents. Methods The urine presence and serum levels of psychotropic substances of adolescents hospitalized due to their acute suicidality but without a known actual suicide attempt (i.e., no acute intoxication or serious self-injuries) were investigated routinely between 01.03.2017 and 31.01.2018. Urine (N = 205) and blood samples (N = 193) were taken at the beginning of closed inpatient admission, i.e., the results of the laboratory analysis reflect outpatient drug intake. The serum levels of psychopharmacological medication and OTC medication were measured. Results Our sample consists of 231 cases (boys: N = 54; girls: N = 177, ratio: 1:3.3), aged 12-17 years (average age: 15,4 years). The most prevalent psychiatric diagnoses were depressive episodes (54%) and adjustment disorders (25%), and girls were more often diagnosed with depressive disorders than boys (boy/girl ratio: 1:9.5, p < 0.0001). More than half of adolescents (56%) used at least one prescribed psychotropic drug at admission (24.8% ≥ two psychotropic drugs). Off-label use of second-generation antipsychotics was significantly more frequent than off-label use of antidepressants (85% vs. 31%, p < 0.01). Adolescents suffering from depressive disorders were significantly more often on-label treated than adolescents with neurotic or stress-related disorders (56% vs. 10%). Female cases with prescribed psychotropic drug use showed significantly more frequent supratherapeutic drug levels than male cases (5% vs. 27%, p < 0.05). Conclusion Female adolescents may have an increased risk of supratherapeutic blood levels, especially when outpatient prescribed psychotropic drugs are off-label used. Measurement of blood levels of outpatient-prescribed psychotropic drugs could be used to enhance the safety and efficacy of the individual psychopharmacological treatment of adolescent suicidal patients. There is an urgent need for more real-world evidence on the effective treatment of adolescents with psychotropic drugs.
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Affiliation(s)
- Isabel Hach
- Department of Education and Science, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Patrick Nonell
- Clinic of Child and Adolescent Psychiatry and Psychotherapy, Klinikum Nürnberg, Paracelsus Medical University Nürnberg, Nürnberg, Germany
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Ma H, Huang H, Li C, Li S, Gan J, Lian C, Ling Y. The antidepressive mechanism of Longya Lilium combined with Fluoxetine in mice with depression-like behaviors. NPJ Syst Biol Appl 2024; 10:5. [PMID: 38218856 PMCID: PMC10787738 DOI: 10.1038/s41540-024-00329-5] [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: 08/05/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
Traditional Chinese medicine is one of the most commonly used complementary and alternative medicine therapies for depression. Integrated Chinese-western therapies have been extensively applied in numerous diseases due to their superior efficiency in individual treatment. We used the meta-analysis, network pharmacology, and bioinformatics studies to identify the putative role of Longya Lilium combined with Fluoxetine in depression. Depression-like behaviors were mimicked in mice after exposure to the chronic unpredictable mild stress (CUMS). The underlying potential mechanism of this combination therapy was further explored based on in vitro and in vivo experiments to analyze the expression of COX-2, PGE2, and IL-22, activation of microglial cells, and neuron viability and apoptosis in the hippocampus. The antidepressant effect was noted for the combination of Longya Lilium with Fluoxetine in mice compared to a single treatment. COX-2 was mainly expressed in hippocampal CA1 areas. Longya Lilium combined with Fluoxetine reduced the expression of COX-2 and thus alleviated depression-like behavior and neuroinflammation in mice. A decrease of COX-2 curtailed BV-2 microglial cell activation, inflammation, and neuron apoptosis by blunting the PGE2/IL-22 axis. Therefore, a combination of Longya Lilium with Fluoxetine inactivates the COX-2/PGE2/IL-22 axis, consequently relieving the neuroinflammatory response and the resultant depression.
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Affiliation(s)
- Huina Ma
- Department of Health, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Hehua Huang
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Chenyu Li
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Shasha Li
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Juefang Gan
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Chunrong Lian
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China
| | - Yanwu Ling
- Department of Human Anatomy, Youjiang Medical University for Nationalities, Baise, 533000, P. R. China.
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Xie S, Cheng Q, Tan S, Li H, Huang T, Xiang Y, Zhou X. The efficacy and acceptability of group trauma-focused cognitive behavior therapy for the treatment of post-traumatic stress disorder in children and adolescents: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 86:127-134. [PMID: 38219423 DOI: 10.1016/j.genhosppsych.2023.11.012] [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: 07/07/2023] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Group trauma-focused cognitive behavior therapy (TF-CBT) is widely used to treat post-traumatic stress disorder (PTSD) in children and adolescents. However, the available evidence remains unclear. METHOD PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations, LILACS, and international trial registers were searched from database inception to April 30, 2022. We included randomized controlled trials (RCTs) that compared TF-CBT with any control condition for treating children and adolescents with PTSD. Analyses were performed using Review Manager version 5.3 and Stata 16.0. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42020206096). RESULTS Eleven RCTs involving 1942 patients were included. Group TF-CBT was significantly more effective than other treatments at post-treatment (standardized mean difference [SMD]: -0.43, 95% confidence interval [CI]: -0.65 to -0.22), follow-up (SMD: -0.33, 95% CI: -0.52 to -0.13), and in relieving depressive symptoms (SMD: -0.29, 95% CI: -0.49 to -0.09), but not in terms of acceptability. Subgroup analyses showed that group TF-CBT was superior to other treatments in studies including children with post-traumatic stress symptoms (PTSS) (SMD: -0.54, 95% CI: -0.79 to -0.28) and psychiatric comorbidities (SMD: -0.48, 95% CI: -0.72 to -0.23). LIMITATIONS The small sample sizes of identified studies limited some findings. CONCLUSION When considering effectiveness at post-treatment and follow-up or the reduction of depressive symptoms, group TF-CBT could be a good choice for children and adolescents with PTSD. Among these patients, those with PTSS or psychiatric comorbidities may benefit the most.
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Affiliation(s)
- Siyu Xie
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; College of Pediatrics, Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qisheng Cheng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Shiyu Tan
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Haomiao Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Tengyue Huang
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Yajie Xiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Sarakbi D, Groll D, Tranmer J, Kessler R, Sears K. Supporting Quality Integrated Care for Adolescent Depression in Primary Care: A Learning System Approach. Int J Integr Care 2024; 24:6. [PMID: 38312480 PMCID: PMC10836164 DOI: 10.5334/ijic.7685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Background Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach. Methods Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups. Results The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%). Discussion While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines. Conclusion Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data.
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Affiliation(s)
- Diana Sarakbi
- Health Quality Programs, Queen’s University, Ontario, Canada
| | - Dianne Groll
- Department of Psychiatry and Psychology, Queen’s University, Ontario, Canada
| | - Joan Tranmer
- School of Nursing and Department of Public Health Sciences, Queen’s University, Ontario, Canada
| | - Rodger Kessler
- Department of Family Medicine, University of Colorado, Colorado, United States
| | - Kim Sears
- School of Nursing and Health Quality Programs, Queen’s University, Ontario, Canada
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Salam RA, Khan MH, Meerza SSA, Das JK, Lewis-Watts L, Bhutta ZA. An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents. Nat Med 2024; 30:290-301. [PMID: 38195753 DOI: 10.1038/s41591-023-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.
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Affiliation(s)
- Rehana A Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Maryam Hameed Khan
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Saqlain Ali Meerza
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
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40
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Sylvester CM, Luby JL, Pine DS. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacology 2024; 49:262-275. [PMID: 37608220 PMCID: PMC10700626 DOI: 10.1038/s41386-023-01709-x] [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: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.
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Affiliation(s)
- Chad M Sylvester
- Washington University Department of Psychiatry, St. Louis, MO, USA.
- Washington University Department of Radiology, St. Louis, MO, USA.
| | - Joan L Luby
- Washington University Department of Psychiatry, St. Louis, MO, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA
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41
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Vöckel J, Spitznagel N, Markser A, Sigrist C, Koenig J. A paucity of evidence in youth: The curious case of transcranial direct current stimulation for depression. Asian J Psychiatr 2024; 91:103838. [PMID: 38000172 DOI: 10.1016/j.ajp.2023.103838] [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: 09/12/2023] [Revised: 10/10/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
A significant proportion of youth with depression do not respond to available treatment. Transcranial direct current stimulation (tDCS) is a promising third-line treatment in depressed adults, but evidence in youth seems scarce. Following the PRISMA guidelines, we conducted a systematic literature review on tDCS treatment for depression in children and adolescents. No published studies were found on the use of tDCS in youth with depression. Given the null-findings, no conclusion can be drawn about the effectiveness of tDCS treatment for adolescent depression. The reasons for this paucity of evidence in light of existing regulatory frameworks and technical challenges are discussed.
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Affiliation(s)
- Jasper Vöckel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany.
| | - Nele Spitznagel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Anna Markser
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Christine Sigrist
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
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42
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Rosell-Hidalgo A, Eakins J, Walker P, Moore AL, Ghafourian T. Risk Assessment of Psychotropic Drugs on Mitochondrial Function Using In Vitro Assays. Biomedicines 2023; 11:3272. [PMID: 38137493 PMCID: PMC10741027 DOI: 10.3390/biomedicines11123272] [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: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Mitochondria are potential targets responsible for some drug- and xenobiotic-induced organ toxicities. However, molecular mechanisms of drug-induced mitochondrial toxicities are mostly unknown. Here, multiple in vitro assays were used to investigate the effects of 22 psychotropic drugs on mitochondrial function. The acute extracellular flux assay identified inhibitors of the electron transport chain (ETC), i.e., aripiprazole, phenytoin, and fluoxetine, an uncoupler (reserpine), substrate inhibitors (quetiapine, carbamazepine, buspirone, and tianeptine), and cytotoxic compounds (chlorpromazine and valproic acid) in HepG2 cells. Using permeabilized HepG2 cells revealed minimum effective concentrations of 66.3, 6730, 44.5, and 72.1 µM for the inhibition of complex-I-linked respiration for quetiapine, valproic acid, buspirone, and fluoxetine, respectively. Assessing complex-II-linked respiration in isolated rat liver mitochondria revealed haloperidol is an ETC inhibitor, chlorpromazine is an uncoupler in basal respiration and an ETC inhibitor under uncoupled respiration (IC50 = 135 µM), while olanzapine causes a mild dissipation of the membrane potential at 50 µM. This research elucidates some mechanisms of drug toxicity and provides some insight into their safety profile for clinical drug decisions.
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Affiliation(s)
- Alicia Rosell-Hidalgo
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Julie Eakins
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Paul Walker
- Cyprotex Discovery Ltd., No. 24 Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; (A.R.-H.); (J.E.)
| | - Anthony L. Moore
- Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9QG, UK;
| | - Taravat Ghafourian
- Department of Pharmaceutical Sciences, Barry & Judy Silverman College of Pharmacy, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, FL 33328-2018, USA
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43
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Hankin BL, Griffith JM. What Do We Know About Depression Among Youth and How Can We Make Progress Toward Improved Understanding and Reducing Distress? A New Hope. Clin Child Fam Psychol Rev 2023; 26:919-942. [PMID: 37285011 PMCID: PMC10245370 DOI: 10.1007/s10567-023-00437-4] [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] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
This paper summarizes many findings about depression among children and adolescents. Depression is prevalent, highly distressing, and exerts considerable burden worldwide. Rates surge from childhood through young adulthood and have increased over the last decade. Many risk factors have been identified, and evidence-based interventions exist targeting mostly individual-level changes via psychological or pharmacological means. At the same time, the field appears stuck and has not achieved considerable progress in advancing scientific understanding of depression's features or delivering interventions to meet the challenge of youth depression's high and growing prevalence. This paper adopts several positions to address these challenges and move the field forward. First, we emphasize reinvigoration of construct validation approaches that may better characterize youth depression's phenomenological features and inform more valid and reliable assessments that can enhance scientific understanding and improve interventions for youth depression. To this end, history and philosophical principles affecting depression's conceptualization and measurement are considered. Second, we suggest expanding the range and targets of treatments and prevention efforts beyond current practice guidelines for evidence-based interventions. This broader suite of interventions includes structural- and system-level change focused at community and societal levels (e.g., evidence-based economic anti-poverty interventions) and personalized interventions with sufficient evidence base. We propose that by focusing on the FORCE (Fundamentals, Openness, Relationships, Constructs, Evidence), youth depression research can provide new hope.
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Affiliation(s)
- Benjamin L Hankin
- Department of Psychology, University of Illinois Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA.
| | - Julianne M Griffith
- Department of Psychology, University of Illinois Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA
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Yan M, Chen L, Yang M, Zhang L, Niu M, Wu F, Chen Y, Song Z, Zhang Y, Li J, Tian J. Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents. Eur Child Adolesc Psychiatry 2023; 32:2091-2108. [PMID: 35262810 DOI: 10.1007/s00787-022-01958-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023]
Abstract
This study systematically reviewed the clinical practice guidelines (CPGs) for depression in children and adolescents and assessed the quality and recommendation consistency of those CPGs. Evidence mapping was presented to illustrate the research trends and identify gaps to guide future research. Literature on CPGs for depression was systematically collected from PubMed, Embase, Web of Science, guideline databases, and psychiatric association/ society websites. The basic information, recommendations, methodological quality, and reporting quality of CPGs were extracted, and the supporting evidence strength for the included CPGs was analyzed in Excel. Four appraisers independently assessed the eligible CPGs using AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarized and analyzed, and the evidence mapping bubble charts were plotted in Excel. After excluding 15,184 records, 12 depression CPGs were eventually proved eligible, six of which were of high quality and six medium quality. A total of 39 major recommendations were summarized, 35 of which were supported by high-quality CPGs. Although direct comparisons are challenging due to differences in grading schemes and research quality, most CPGs share many pivotal recommendations that can help guide clinical practice. However, the evidence for some clinical problems is still lacking. Thus, more research is necessary on the screening and treatment of children and adolescents to put forward more evidence-based and high-quality recommendations.
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Affiliation(s)
- Meili Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Fangfang Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- Shangluo Vocational and Technical College, Shangluo, Shanxi, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China.
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Brent DA, Melhem NM. Editorial: Prevention's Power: Depression Incidence Halved 15 Years After Participation in the Family Bereavement Program. J Am Acad Child Adolesc Psychiatry 2023; 62:1191-1193. [PMID: 37328142 DOI: 10.1016/j.jaac.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
Prevention can be powerful. In the current issue of this Journal, Sandler et al. report on the long-term effects of the Family Bereavement Program (FBP), an intervention designed to promote resilience among parentally bereaved youth, as assessed 15 years after receipt of the initial intervention.1 Youth who received the FBP had half the rate of depression compared to those who received the comparison condition (13.46% vs 28.05%). This effect is as large or larger than many of our evidence-based treatments for depression, and considerably more enduring.2 An additional, elegant feature of this paper is that it identifies some mechanisms by which the FBP appears to exert its preventive effects.
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Affiliation(s)
- David A Brent
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania.
| | - Nadine M Melhem
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Rimvall MK, Wesselhoeft R. Commentary: Mind the blip in the curve when assessing educational attainment in youths - a reflection on Wickersham et al. (2023). J Child Psychol Psychiatry 2023; 64:1628-1630. [PMID: 37545148 DOI: 10.1111/jcpp.13878] [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] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
Dr. Wickersham et al.'s study linked educational and health records providing important knowledge on educational trajectories in youths with mental disorders. They found that youths diagnosed with depression prior to age 18 were more likely to have a decline in educational attainment over time than youths without depression. Furthermore, educational attainment trajectories showed some specificity with different patterns between youths with depression and youths with neurodevelopmental disorders. In this commentary, we highlight the clinical implications of these findings, showing that low or declining educational attainment in youths might serve as a marker for psychopathology, providing the opportunity to identify youths that could benefit from coordinated interventions across diagnostic boundaries.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Fanxing K, Gao Y, Herold F, Hossain MM, Yeung AS, Ng JL, Kramer AF, Zou L. Relationships between physical activity, sleep, and screen time with academic performance and psychological functioning among US children and adolescents with depression. Complement Ther Clin Pract 2023; 53:101806. [PMID: 37944191 DOI: 10.1016/j.ctcp.2023.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This cross-sectional study examined the relationships between adherence to 24-HMB guidelines (including physical activity [PA], screen time [ST], and sleep) with academic performance and psychological functioning among children and adolescents with depression. METHODS This study consists of 2165 participants aged 6-17 years with depression. Independent variables were components of 24-HMB guideline adherence, while outcomes of interest were academic performance (i.e., caring about school performance and completion of required homework) and psychological functioning (i.e., resilience and self-regulation). Logistic regression analysis was conducted while adjusting for confounding variables. RESULTS Only 1.03 % of the participants adhered to PA + ST + Sleep guidelines. Compared to non-adherence, adherence to PA + ST guidelines was significantly linked to a greater likelihood of caring about school performance (OR = 2.17), while ST + Sleep guidelines adherence was significantly linked to a greater likelihood of caring about school performance (OR = 2.02), completing homework (OR = 2.91), resilience (OR = 2.51), and self-regulation (OR = 2.51). Furthermore, adherence to PA + ST + Sleep guidelines was significantly linked to a higher likelihood of caring about school performance (OR = 5.01), resilience (OR = 2.49), and self-regulation (OR = 2.88) among these participants with depression. CONCLUSION Adhering to 24-HMB guidelines is positively linked to academic performance and psychological functioning among children and adolescents with depression. Thus, establishing healthy lifestyle behaviors should be promoted in school settings.
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Affiliation(s)
- Kong Fanxing
- School of Physical Education, Suihua University, Suihua, 152000, China; School of Physical Education, Anqing Normal University, Anqing, 246052, China
| | - Yanping Gao
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, Brandenburg, University of Potsdam, Potsdam, Germany
| | - M Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, TX, 77204, USA; Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, TX, 77204, USA
| | | | - Jonathan Leo Ng
- School of Education, College of Design and Social Context, RMIT University, Victoria, 3083, Australia
| | - Arthur F Kramer
- Center for Cognitive and Brain Health, Northeastern University, Boston, MA, USA; Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Liye Zou
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, China
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He Y, Gan X, Li X, Wang T, Li J, Lei T, Huang Y, Liu R, Chen F, Teng T, Xie Y, Ouyang X, Zhou X. Sequenced treatment alternatives to relieve adolescent depression (STAR-AD): a multicentre open-label randomized controlled trial protocol. BMC Psychiatry 2023; 23:789. [PMID: 37891522 PMCID: PMC10612344 DOI: 10.1186/s12888-023-05221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is a prevalent mental health problem with low treatment success rates. Whether fluoxetine or fluoxetine combined with cognitive-behavioural therapy (CBT) is the more effective initial treatment for adolescent MDD remains controversial, and few studies have investigated whether treatment switching or augmentation is preferred when the initial treatment is not working well. METHODS We developed a multicentre open-label Sequential Multiple Assignment Randomized Trial (SMART) design, consisting of two phases lasting 8 weeks each. In phase 1 (at baseline), patients will be recruited and grouped in fluoxetine group or fluoxetine combined with CBT group by patient self-selection. In phase 2 (after 8 weeks of treatment), the nonresponders will be randomly assigned to six groups, in which participants will switch to sertraline, vortioxetine, or duloxetine or added aripiprazole, olanzapine, or lithium carbonate to fluoxetine. After the full 16 weeks of treatment, we will assess the long-term sustainability of the treatment effects by evaluating participants during their subsequent naturalistic treatment. The primary outcome will be the response rate, determined by the Children's Depression Rating Scale-Revised (CDRS-R). Secondary outcomes include the change in scores on the Beck Depression Inventory (BDI), the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and the Safe Assessment. DISCUSSION The results from this study will aid clinicians in making informed treatment selection decisions for adolescents with MDD. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov with Identifier: NCT05814640.
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Affiliation(s)
- Yuqian He
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xieyu Gan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ting Wang
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Tingting Lei
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yajie Huang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Ruibing Liu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fei Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Teng Teng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yuxin Xie
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, The Second Xiangya Hospital, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, Central South University, Changsha, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China.
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Wang L, Zhou L, Zhu Y, Yan J, Bu N, Fei W, Wu F. Trends in prescription therapy for adolescents with depression in nine major areas of China during 2017-2021. Front Psychiatry 2023; 14:1175002. [PMID: 37953934 PMCID: PMC10639118 DOI: 10.3389/fpsyt.2023.1175002] [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: 02/27/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To date, no national-scale drug usage survey for adolescents with depression has been conducted in China, and the purpose of this study was to examine the national trends in prescriptions in Chinese adolescent depression patients from 2017 to 2021. Methods Prescribing data were extracted from the Hospital Prescription Analysis Cooperative Project. The average number of patients per year, the cost of treatment, and the prescription patterns (monotherapy vs. combination therapy) were analyzed, and subgroup analyses were conducted depending on age, sex, and drug class. Results The study included 674,099 patients from 136 hospitals located in nine major areas of China. Of all patients, the proportion of adolescents increased from 1.63% in 2017 to 6.75% in 2021. Visits by adolescent depression patients increased from 1,973 in 2017 to 9,751 in 2021, and the corresponding cost increased from 607,598 Chinese Yuan in 2017 to 2,228,884 Chinese Yuan in 2021. The incidence of adolescent depression among female individuals was far beyond that among male individuals. Combination therapy was more frequent than monotherapy, and the most commonly prescribed drugs were antidepressants, antipsychotics, antiepileptics, and antianxietics. Despite the use of sertraline decreasing from 47.90 to 43.39%, it was the most frequently used drug. Conclusion In summary, the prescriptions and cost of treatment for adolescent depression patients both increased rapidly. The widespread use of those drugs with weak clinical evidence reflects the current state of China, which should arouse our attention. The study can provide references for clinical treatment decisions and a basis for more efficient allocation of healthcare resources by the government.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linpo Zhou
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yao Zhu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Yan
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Bu
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Fei
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Wu
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
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Yang L, Cao M, Tian J, Cui P, Ai L, Li X, Li H, Gao M, Fang L, Zhao L, Gong F, Zhou C. Identification of Plasma Inflammatory Markers of Adolescent Depression Using the Olink Proteomics Platform. J Inflamm Res 2023; 16:4489-4501. [PMID: 37849645 PMCID: PMC10577244 DOI: 10.2147/jir.s425780] [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: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose The quality of life of worldwide adolescents has been seriously affected by depression. Notably, the inflammatory response is closely associated with the pathophysiology of depression. The present study applied a novel targeted proteomics technology, Olink proximity extension assay (PEA), to profile circulating immune-related proteins in adolescents with depression. Methods In the present study, the expression levels of 92 inflammation-related proteins were compared between adolescents with depression (ADs) (n=15) and healthy controls (HCs) (n=15), using the OLINK PEA inflammation panel. We further validated 5 top proteins that were identified through KEGG and GO analyses between 40 HCs and 50 ADs, including CCL4, CXCL5, CXCL6, CXCL11, and IL-18 using enzyme linked immunosorbent assay (ELISA). Results We identified 13 differentially expressed proteins between the two cohorts, including 5 up-regulated and 8 down-regulated proteins. Among them, the TRAIL protein levels were significantly negatively correlated with the HAMA-14 score (r=-0.538, p= 0.038), and the levels of transforming growth factor α (TGF-α) were significantly associated with a change in appetite (r = -0.658, p = 0.008). After validation by ELISA, CCL4, CXCL5, CXCL11, and IL-18 showed significant changes between ADs and HCs (p < 0.05), while CXCL6 showed an up-regulated tendency in ADs (p=0.0673). The pooled diagnostic efficacy (area under the curve [AUC]) of these five inflammation markers in clinical diagnosis for adolescent depression was 0.819 (95% CI: 0.735-0.904). Conclusion We report a number of inflammation-related plasma biomarkers, which uncover a potential involvement of chemokines, cytokines, and cytokine receptors in adolescent depression. Their roles in the pathophysiology of depression need to be further elucidated.
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Affiliation(s)
- Ling Yang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, People’s Republic of China
| | - Maolin Cao
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jing Tian
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Peijin Cui
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Ling Ai
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xue Li
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hua Li
- Department of Ophthalmology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Menghan Gao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Liang Fang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, People’s Republic of China
- Chongqing Clinical Research Center for Geriatric Disease, Chongqing, People’s Republic of China
| | - Libo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, People’s Republic of China
| | - Fang Gong
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, People’s Republic of China
- Chongqing Clinical Research Center for Geriatric Disease, Chongqing, People’s Republic of China
| | - Chanjuan Zhou
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Clinical Research Center for Geriatric Disease, Chongqing, People’s Republic of China
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