Treating depression with antidepressants: drug-placebo efficacy debates limit broader considerations

Using metaphors to build hope and hopefulness from depression

Helplessness and hopelessness are common key dynamics of depression that often inhibit therapeutic progress and client recovery. Based on a case example, this article examines the processes for effectively communicating therapeutic interventions aimed toward building hope when other approaches have failed. It explores the use of therapeutic metaphors including assessing for positive outcomes, building the PRO Approach for creating therapeutic metaphors and using Hope Theory as an example of an evidence-based process for facilitating both hope and enhanced treatment outcomes. It concludes with an illustrative metaphor within a hypnotic model and a step-by-step process for building your own hope-enhancing metaphors.

Serum metabolomic responses to aerobic exercise in rats under chronic unpredictable mild stress

This study analyzed the effects of aerobic exercise on endogenous serum metabolites in response to chronic unpredictable mild stress (CUMS) using a rat model, aiming to identify the metabolic regulatory pathways involved in the antidepressant effect resulted from a 28-day treadmill aerobic exercise intervention. The animals were randomly divided into four groups (n = 8): normal control, normal with aerobic exercise, CUMS control, and CUMS with aerobic exercise. Body weight, sucrose preference and open field tests were performed weekly during the intervention period for changes in depressant symptoms. Serum metabolic profiles obtained by using the LC-MS/MS metabolomics were analyzed to explore the regulatory mechanism for the effect of the aerobic exercise on depression. Behavior tests showed that the aerobic exercise resulted in a significant improvement in depression-like behavior in the CUMS rats. A total of 21 differential metabolites were identified as being associated with depression in serum metabolic profile, of which the aerobic exercise significantly modulated 15, mainly related to amino acid metabolism and energy metabolism. Collectively, this is the first study that LC-MS/MS techniques were used to reveal the modulatory effects of aerobic exercise on the serum metabolic profile of depressed rats and the findings further enriched our understanding of potential mechanisms of aerobic exercise interventions on depression.

Medications development for substance-use disorders: contextual influences (dis)incentivizing pharmaceutical-industry positioning

INTRODUCTION

The significant contribution of substance-use disorders (SUDs) to the global-disease burden and associated unmet medical needs has not engendered a commensurate level of pharma-industry research and development (R&D) for novel SUD therapeutics invention. Analysis of contextual factors shaping this position suggests potential routes toward incentivizing R&D commitment for that purpose.

AREAS COVERED

This article considers multiple primary factors that have consorted to disincentivize pharma industry's operating in the SUD space: ill-understood pathology; variegated treatments and patient profiles; involved clinical trials; and - with particular reference to SUDs-negative cultural/business stigmas and shallow commercial precedent. Industry incentivization for SUD drug innovation requires progress on several fronts, including: translational experimental data and systems; personalized, holistic SUD treatment approaches; interactions among pharma, nonindustry constituencies, and the medical profession with vested interests in countering negative stereotypes and expanding SUD treatment options; and public-private alliances focused on improving SUD pharmacotherapy.

EXPERT OPINION

Given the well-entrenched business stance whereby the prospect of future profits in major markets largely determines drug-company R&D investment trajectory, strategic initiatives offering substantial reductions in the risks and opportunity (i.e., time and money) costs associated with SUD drug discovery are likely to be the most potent drivers for encouraging mainstream industry positioning in this therapeutic area. Such initiatives could originate from front-loaded R&D operational and back-loaded patent, regulatory, marketing and health-care policy reforms. These may be too involved and protracted for the turbulent pharmaceutical industry to entertain amid its recent retrenchment from psychiatric/CNS diseases and intense pressures to increase productivity and shareholder value.

When the bough breaks: rethinking treatment strategies for perinatal depression

Awareness of depression among OB-GYN physicians has increased with the result that more than 13% of pregnant women in the United States receive prescriptions for antidepressant medications. But the safety and effectiveness of these compounds has been exaggerated while the effectiveness of psychotherapy has been overlooked and distorted and various medical guidelines for treatment of perinatal depression have been downplayed or ignored. This article addresses the common fears and misconceptions surrounding treatment of depression during pregnancy and after childbirth. The effectiveness of strategic cognitive-behavioral therapy enhanced with hypnosis offers excellent results without the risks associated with these medications. Targets for focused intervention are identified and discussed.