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Ndu CC, Abotsi WKM, Mante PK. Investigation of Herb-Drug Interactions between Xylopia aethiopica, Its Principal Constituent Xylopic Acid, and Antidepressants. Adv Pharmacol Pharm Sci 2024; 2024:9923801. [PMID: 38826835 PMCID: PMC11144068 DOI: 10.1155/2024/9923801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Depression affects an estimated 350 million people worldwide and is implicated in up to 60% of suicides. Only about 60-70% of patients respond to antidepressant therapy. One of the factors causing patients to not attain therapeutic goals is herb-drug interactions. Objective To investigate any potential herb-drug interaction that might exist between Xylopia aethiopica extract (XAE) or xylopic acid (XA) and selected conventional antidepressants (imipramine, fluoxetine, and venlafaxine) in mice. Methods Dried, powdered fruits of Xylopia aethiopica were cold macerated in 70% ethanol to obtain XAE. XA was isolated by cold macerating dried fruits of Xylopia aethiopica in petroleum ether, crystallising impure XA with ethyl acetate, and purifying XA crystals with 96% ethanol. Pharmacodynamic interaction was assessed via isobolographic analysis of tail suspension tests of the agents individually and in their respective combinations. Pharmacokinetic interaction was assessed by monitoring the effect of coadministrations on the plasma concentration of antidepressants and xylopic acid via HPLC analysis. Results XAE and XA in mice showed significant antidepressant-like activity in the tail suspension test. With interaction indices less than one, synergism of antidepressant effect was observed in the Xylopia aethiopica extract/fluoxetine (γXAE/FL = 0.502), Xylopia aethiopica extract/imipramine (γXAE/IP = 0.322), Xylopia aethiopica extract/venlafaxine (γXAE/VL = 0.601), xylopic acid/imipramine (γXA/IP = 0.556), xylopic acid/venlafaxine (γXA/VL = 0.451), and xylopic acid/fluoxetine (γXA/FL = 0.298) combinations, which may be potentially due to elevation of serotonergic neurotransmission via varying mechanisms. The AUC of imipramine (AUCIP = 1966 ± 58.98 µg/ml.h) was significantly (P < 0.0001) reduced by Xylopia aethiopica extract (AUCIP = 1228 ± 67.40 µg/ml.h) and xylopic acid (AUCIP = 1250 ± 55.95 µg/ml.h), while the AUC of xylopic acid (AUCXA = 968.10 ± 61.22 µg/ml.h) was significantly (P < 0.0001) reduced by venlafaxine (AUCXA = 285.90 ± 51.92 µg/ml.h) and fluoxetine (AUCXA = 510.60 ± 44.74 µg/ml.h), possibly due to the effect of interfering agents on gastric emptying hence reducing oral absorption. Conclusion Xylopia aethiopica extract and xylopic acid interacted synergistically with imipramine, fluoxetine, and venlafaxine and reduced the systemic circulation of imipramine.
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Affiliation(s)
- Christian C. Ndu
- Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wonder K. M. Abotsi
- Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Priscilla K. Mante
- Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sokol Y, Rosensweig C, Levin C, Glatt S. Temporal self-appraisals associated with suicide-related thoughts and behaviors. J Affect Disord 2024; 350:148-154. [PMID: 38228274 DOI: 10.1016/j.jad.2024.01.081] [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: 09/05/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Temporal self-appraisal (TSA) is the trajectory of self-appraisal over time, including how a person views their past and future selves in relation to their present self. In this study, we examined the TSA of individuals with and without a history of suicide-related thoughts and behaviors (STBs). METHODS Using Amazon Mechanical Turk for recruitment, we studied 397 participants on validated measures of TSA, STBs, and mood. RESULTS The non-STB group (n = 291) had a TSA trajectory similar to that previously found for nonclinical populations, with perceived self-improvement over time. In contrast, the TSA of the STB group (n = 106) had two distinct qualities: their TSA profiles were more negative at all time points (past, present, and future) than the non-STB group, and they displayed similar anticipated present-to-future growth as the non-STB group but perceived minimal past-to-present change. These differences persisted when controlling for depression, anxiety, and stress, suggesting a distinct STB-related TSA profile independent of comorbid affective states. LIMITATIONS This study is limited by the use of self-report measures and cross-sectional design. CONCLUSIONS By investigating TSA, this study provides insights into the unique aspects of self-appraisal associated with having a history of STBs and emphasizes the need for therapeutic interventions that foster self-continuity and positive self-appraisal across time. Future research should focus on clarifying the mechanisms underlying this distinct self-appraisal pattern in the STB group and the effects of interventions that enhance temporal self-appraisal.
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Affiliation(s)
- Yosef Sokol
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; School of Health Sciences, Touro University and College Systems, New York, NY, USA.
| | - Chayim Rosensweig
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Chynna Levin
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Sofie Glatt
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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Wang J, Carru C, Sedda S, Fiori PL, Li Z, Chen Z. Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis. Int J Gynaecol Obstet 2024; 165:67-75. [PMID: 37688384 DOI: 10.1002/ijgo.15091] [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: 06/13/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence. METHODS The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate. CONCLUSION In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.
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Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Stefania Sedda
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Pier Luigi Fiori
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Zhi Li
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhichao Chen
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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Liu Y, Lv B, Tang K, Qu H, Yu F, Shi Y. Si-Ni-San reverses dietary fat absorption defects in a murine model of depression. Biomed Pharmacother 2023; 168:115677. [PMID: 37857252 DOI: 10.1016/j.biopha.2023.115677] [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: 08/23/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
Depression is often associated with fatigue/energy loss. However, we lack a detailed understanding of the factors explaining this association. In this study, we uncovered that depressed mice have a defect in fat absorption, resulting in weight loss and reduced circulating lipid levels. Si-Ni-San (SNS), a basic formula of traditional Chinese medicine (TCM) for the treatment of depression, was found to not only alleviate depression-like behaviors, but also reverse the weight loss and dietary fat absorption of depressed mice. We found that SNS improved body weight and circulating lipid levels of depressed mice by up-regulating proteins [such as FFA uptake protein (CD36), TAG synthesis proteins (GPAT3, MOGAT2, DGAT1 and DGAT2) and chylomicron packaging proteins (MTP and APOB)] in the fat absorption pathway. Furthermore, cell-based results conducted with LPS-stimulated mouse MODE-K and human Caco-2 cells support that SNS, as well as Sinensetin (SIN) and Nobiletin (NOB), the two active components of the formula, have a role in regulating lipid absorption. Mechanistic studies revealed that SNS reverses body weight and fat absorption defects of depressed mice in part through the NR1D1/BMAL1/DGAT2 axis. These findings advance our understanding of the crosstalk between depression and energy loss, highlight the importance of gut function in disease management, and provide a basis for the application of SNS in the clinical treatment of depression and related disorders.
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Affiliation(s)
- Yuanyuan Liu
- School of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Baojiang Lv
- School of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kanran Tang
- School of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haotian Qu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Yu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yafei Shi
- School of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Hoopsick RA, Yockey RA. A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019. J Psychiatr Res 2023; 165:34-40. [PMID: 37459776 DOI: 10.1016/j.jpsychires.2023.07.009] [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: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023]
Abstract
There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL, 61820, USA.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 709C, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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Ahmed MS, Ahmed N. A Fast and Minimal System to Identify Depression Using Smartphones: Explainable Machine Learning-Based Approach. JMIR Form Res 2023; 7:e28848. [PMID: 37561568 PMCID: PMC10450542 DOI: 10.2196/28848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Existing robust, pervasive device-based systems developed in recent years to detect depression require data collected over a long period and may not be effective in cases where early detection is crucial. Additionally, due to the requirement of running systems in the background for prolonged periods, existing systems can be resource inefficient. As a result, these systems can be infeasible in low-resource settings. OBJECTIVE Our main objective was to develop a minimalistic system to identify depression using data retrieved in the fastest possible time. Another objective was to explain the machine learning (ML) models that were best for identifying depression. METHODS We developed a fast tool that retrieves the past 7 days' app usage data in 1 second (mean 0.31, SD 1.10 seconds). A total of 100 students from Bangladesh participated in our study, and our tool collected their app usage data and responses to the Patient Health Questionnaire-9. To identify depressed and nondepressed students, we developed a diverse set of ML models: linear, tree-based, and neural network-based models. We selected important features using the stable approach, along with 3 main types of feature selection (FS) approaches: filter, wrapper, and embedded methods. We developed and validated the models using the nested cross-validation method. Additionally, we explained the best ML models through the Shapley additive explanations (SHAP) method. RESULTS Leveraging only the app usage data retrieved in 1 second, our light gradient boosting machine model used the important features selected by the stable FS approach and correctly identified 82.4% (n=42) of depressed students (precision=75%, F1-score=78.5%). Moreover, after comprehensive exploration, we presented a parsimonious stacking model where around 5 features selected by the all-relevant FS approach Boruta were used in each iteration of validation and showed a maximum precision of 77.4% (balanced accuracy=77.9%). Feature importance analysis suggested app usage behavioral markers containing diurnal usage patterns as being more important than aggregated data-based markers. In addition, a SHAP analysis of our best models presented behavioral markers that were related to depression. For instance, students who were not depressed spent more time on education apps on weekdays, whereas those who were depressed used a higher number of photo and video apps and also had a higher deviation in using photo and video apps over the morning, afternoon, evening, and night time periods of the weekend. CONCLUSIONS Due to our system's fast and minimalistic nature, it may make a worthwhile contribution to identifying depression in underdeveloped and developing regions. In addition, our detailed discussion about the implication of our findings can facilitate the development of less resource-intensive systems to better understand students who are depressed and take steps for intervention.
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Affiliation(s)
- Md Sabbir Ahmed
- Design Inclusion and Access Lab, North South University, Dhaka, Bangladesh
| | - Nova Ahmed
- Design Inclusion and Access Lab, North South University, Dhaka, Bangladesh
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Khalaf AM, Alubied AA, Khalaf AM, Rifaey AA. The Impact of Social Media on the Mental Health of Adolescents and Young Adults: A Systematic Review. Cureus 2023; 15:e42990. [PMID: 37671234 PMCID: PMC10476631 DOI: 10.7759/cureus.42990] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Adolescents increasingly find it difficult to picture their lives without social media. Practitioners need to be able to assess risk, and social media may be a new component to consider. Although there is limited empirical evidence to support the claim, the perception of the link between social media and mental health is heavily influenced by teenage and professional perspectives. Privacy concerns, cyberbullying, and bad effects on schooling and mental health are all risks associated with this population's usage of social media. However, ethical social media use can expand opportunities for connection and conversation, as well as boost self-esteem, promote health, and gain access to critical medical information. Despite mounting evidence of social media's negative effects on adolescent mental health, there is still a scarcity of empirical research on how teens comprehend social media, particularly as a body of wisdom, or how they might employ wider modern media discourses to express themselves. Youth use cell phones and other forms of media in large numbers, resulting in chronic sleep loss, which has a negative influence on cognitive ability, school performance, and socio-emotional functioning. According to data from several cross-sectional, longitudinal, and empirical research, smartphone and social media use among teenagers relates to an increase in mental distress, self-harming behaviors, and suicidality. Clinicians can work with young people and their families to reduce the hazards of social media and smartphone usage by using open, nonjudgmental, and developmentally appropriate tactics, including education and practical problem-solving.
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Affiliation(s)
- Abderrahman M Khalaf
- Psychiatry Department, Saudi Commission for Health Specialties, Ministry of Health, Riyadh, SAU
| | - Abdullah A Alubied
- Psychiatry Department, Saudi Commission for Health Specialties, Ministry of Health, Riyadh, SAU
| | - Ahmed M Khalaf
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Yao Y, Yao J, Chen S, Zhang X, Meng H, Li Y, Lu L. Psychological Capital and Self-Acceptance Modified the Association of Depressive Tendency with Self-Rated Health of College Students in China during the COVID-19 Pandemic. Behav Sci (Basel) 2023; 13:552. [PMID: 37503999 PMCID: PMC10376835 DOI: 10.3390/bs13070552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND To explore the association between the self-reported health status, depressive tendency, psychological capital, and self-acceptance of college students in China during the COVID-19 pandemic. METHODS Using the online survey platform "questionnaire star", a two-phase cross-sectional study was conducted on a total number of 1438 undergraduates with informed consents. The questionnaires of Self-Rated Health Measurement Scale (SRHMS), the Center for Epidemiological Studies-Depression Scale (CES-D), Psychological Capital Questionnaire (PCQ-24), and self-acceptance questionnaire were administered to each participant. RESULTS Male college students had significantly higher depressive tendency scores than female (17.59 vs. 15.82) (p < 0.01). College students having no siblings had significantly higher psychological capital scores than those having siblings (108.63 vs. 105.60) (p < 0.05). Exercise had significantly positive associations with self-rated health, psychological capital, and self-acceptance scores, while online time per day had significantly negative associations. Multivariate analysis showed that the interaction between depressive tendency, psychological capital, and self-acceptance was statistically significant (β = 0.004, p = 0.013 for phase 1 and β = 0.002, p = 0.025 for phase 2) in health status with depressive tendency ranking the top (β = -0.54 for phase 1 and -0.41 for phase 2, p < 0.001). Mediation analysis showed that psychological capital and self-acceptance modified the association of depressive tendency with health status. CONCLUSION Physical exercise is beneficial to both physical and psychological health. Depressive tendency is the main risk factor that associates with self-rated health. Regardless of depressive tendency level, high psychological capital and self-acceptance could improve college students' health.
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Affiliation(s)
- Yongcheng Yao
- School of Mathematics and Statistics, Zhengzhou Normal University, Zhengzhou 450044, China
| | - Junyan Yao
- College of Elementary Education, Capital Normal University, Beijing 100048, China
| | - Shuyan Chen
- School of Mathematics and Statistics, Zhengzhou Normal University, Zhengzhou 450044, China
| | - Xiaohui Zhang
- School of Mathematics and Statistics, Zhengzhou Normal University, Zhengzhou 450044, China
| | - Hongling Meng
- School of Mathematics and Statistics, Zhengzhou Normal University, Zhengzhou 450044, China
| | - Yuping Li
- School of Mathematics and Statistics, Zhengzhou Normal University, Zhengzhou 450044, China
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT 06520-8034, USA
- School of Medicine, Yale University, New Haven, CT 06520-8034, USA
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9
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Koh YS, Shahwan S, Jeyagurunathan A, Abdin E, Vaingankar JA, Chow WL, Chong SA, Subramaniam M. Prevalence and correlates of suicide planning and attempt among individuals with suicidal ideation: Results from a nationwide cross-sectional survey. J Affect Disord 2023; 328:87-94. [PMID: 36791970 DOI: 10.1016/j.jad.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Suicidality spans from having suicidal ideation to planning and making an attempt. However, not all individuals with suicidal thoughts will proceed to plan or attempt suicide. Our study investigated (i) the prevalence of suicide planning and attempt among those with suicidal ideation and (ii) their associations with sociodemographic characteristics, mental disorders, adverse childhood events and prior suicidal behaviour. METHOD This cross-sectional analysis utilised data from Singapore Mental Health Study 2016. Only respondents with suicidal ideation were included. A total of 411 and 365 individuals were examined to establish the prevalence of suicide planning and attempt respectively. Multivariable logistic regressions were performed to determine associations. RESULTS The prevalence of suicide planning and attempt were 17.7 % and 10.6 % respectively, with >80.0 % occurring within a year of suicidal ideation. Suicide planning was more likely among those who had mood disorders. Suicide attempt was more likely for those were currently married, had lower educational qualifications, history of anxiety disorders, history of emotional neglect and parental separation. LIMITATIONS Recall bias may be present because the age of onset for various mental disorders and suicidal behaviours were self-reported. As suicide was criminalised when the study was conducted, the prevalence of suicidal behaviours may have been underestimated. CONCLUSION Individuals at risk of suicide planning and attempt should be identified early since most of them progressed within a year. Findings suggest the importance of including prior suicide behaviour and history of dysfunctional family and emotional abuse in suicide risk assessment and intervention.
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Affiliation(s)
- Yen Sin Koh
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Montano CB, Jackson WC, Vanacore D, Weisler R. Considerations when selecting an antidepressant: a narrative review for primary care providers treating adults with depression. Postgrad Med 2023:1-17. [PMID: 36912037 DOI: 10.1080/00325481.2023.2189868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Major depressive disorder (MDD) is a debilitating mental disorder that can be treated with a number of different antidepressant therapies, each with its own unique prescribing considerations. Complicating the selection of an appropriate antidepressant for adults with MDD is the heterogeneity of clinical profiles and depression subtypes. Additionally, patient comorbidities, preferences, and likelihood of adhering to treatment must all be considered when selecting an appropriate therapy. With the majority of prescriptions being written by primary care practitioners, it is appropriate to review the unique characteristics of all available antidepressants, including safety considerations. Prior to initiating antidepressant treatment and when patients do not respond adequately to initial therapy and/or exhibit any hypomanic or manic symptoms, bipolar disorder must be ruled out, and evaluation for psychiatric comorbidities must be considered as well. Patients with an inadequate response may then require a treatment switch to another drug with a different mechanism of action, combination, or augmentation strategy. In this narrative review, we propose that careful selection of the most appropriate antidepressant for adult patients with MDD based on their clinical profile and comorbidities is vital for initial treatment selection.Strategies must be considered for addressing partial and inadequate responses as well to help patients achieve full remission and sustained functional recovery. This review also highlights data for MDD clinical outcomes for which gaps in the literature have been identified, including the effects of antidepressants on functional outcomes, sleep disturbances, emotional and cognitive blunting, anxiety, and residual symptoms of depression.
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Affiliation(s)
- C Brendan Montano
- Montano Wellness LLC, CT Clinical Research, University of Connecticut Medical School, Farmington, CT, USA
| | - W Clay Jackson
- West Cancer Center, Department of Family Medicine and Department of Psychiatry, University of Tennessee College of Medicine, Memphis, TN, USA
| | | | - Richard Weisler
- P.A. & Associates; Department of Psychiatry, Duke University, Durham, NC, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tan C, Yan Q, Ma Y, Fang J, Yang Y. Recognizing the role of the vagus nerve in depression from microbiota-gut brain axis. Front Neurol 2022; 13:1015175. [PMID: 36438957 PMCID: PMC9685564 DOI: 10.3389/fneur.2022.1015175] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 08/08/2023] Open
Abstract
Depression is a worldwide disease causing severe disability, morbidity, and mortality. Despite abundant studies, the precise mechanisms underlying the pathophysiology of depression remain elusive. Recently, cumulate research suggests that a disturbance of microbiota-gut-brain axis may play a vital role in the etiology of depression while correcting this disturbance could alleviate depression symptoms. The vagus nerve, linking brain and gut through its afferent and efferent branches, is a critical route in the bidirectional communication of this axis. Directly or indirectly, the vagus afferent fibers can sense and relay gut microbiota signals to the brain and induce brain disorders including depression. Also, brain changes in response to stress may result in gut hyperpermeability and inflammation mediating by the vagal efferents, which may be detrimental to depression. Notably, vagus nerve stimulation owns an anti-inflammatory effect and was proved for depression treatment. Nevertheless, depression was accompanied by a low vagal tone, which may derive from response to stress and contribute to pathogenesis of depression. In this review, we aim to explore the role of the vagus nerve in depression from the perspective of the microbiota-gut-brain axis, highlighting the relationship among the vagal tone, the gut hyperpermeability, inflammation, and depression.
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Affiliation(s)
- Chaoren Tan
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, China
| | - Qiqi Yan
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Science, Beijing, China
| | - Yue Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongsheng Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, China
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12
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Chee KY, Muhdi N, Ali NH, Amir N, Bernardo C, Chan LF, Ho R, Ittasakul P, Kwansanit P, Mariano MP, Mok YM, Tran DT, Trinh TBH. A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age. BMC Psychiatry 2022; 22:489. [PMID: 35864465 PMCID: PMC9306096 DOI: 10.1186/s12888-022-04140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. METHODS A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. RESULTS Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification - incorporating both severity and temporality, or using a prevention-focused risk formulation - should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. CONCLUSIONS There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.
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Affiliation(s)
- Kok Yoon Chee
- NEURON, Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
| | - Nalini Muhdi
- Department of Psychiatry, Dr Soetomo General Hospital; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Nor Hayati Ali
- Department of Psychiatry & Mental Health, Selayang Hospital, Selayang, Selangor, Malaysia
| | - Nurmiati Amir
- Department of Psychiatry, Ciptomangunkusumo Hospital; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carmina Bernardo
- Mood and Anxiety Resource and Referral Center, Professional Services, Department of Neuroscience, Makati Medical Center, Makati City, Philippines
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roger Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Melissa Paulita Mariano
- Department of Psychiatry, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Yee Ming Mok
- Institute of Mental Health, Singapore, Singapore
| | - Duy Tam Tran
- Ho Chi Minh Psychiatric Hospital, Ho Chi Minh, Vietnam
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13
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Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women. Community Ment Health J 2022; 58:595-605. [PMID: 34184153 DOI: 10.1007/s10597-021-00862-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age 25.4 years; 93% Black/African American) referred to a mental health care manager in an urban women's clinic. Self-report and retrospective chart review data were utilized. Chi-squared and Fisher's Exact tests were performed to assess bivariate relationships between ACEs and mental health and substance use outcomes. Multivariate logistic regressions were used to examine the impact of ACEs on mental health and substance use, adjusting for marital status, education, and age. Findings indicate high levels of childhood adversity, specifically childhood abuse, are associated with negative perinatal mental health and substance use outcomes, including suicidal thoughts, anxiety, mood dysregulation, and tobacco and marijuana use. Inquiring about ACEs during prenatal care and/or in community health clinics may help identify patients' overall risk and provide opportunities for intervention for mothers and their infants.
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14
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Montano CB, Jackson WC, Vanacore D, Weisler RH. Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD). Neuropsychiatr Dis Treat 2022; 18:867-879. [PMID: 35440869 PMCID: PMC9013418 DOI: 10.2147/ndt.s337703] [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: 09/09/2021] [Accepted: 03/04/2022] [Indexed: 01/10/2023] Open
Abstract
Primary care clinicians have a vital role to play in the diagnosis and management of patients with major depressive disorder (MDD). This includes screening for MDD as well as identifying other possible psychiatric disorders including bipolar disorder and/or other comorbidities. Once MDD is confirmed, partnering with patients in the shared decision-making process while considering different treatment options and best management of MDD over the course of their illness is recommended. Vortioxetine has been approved for the treatment of adults with MDD since 2013, and subsequent US label updates indicate that vortioxetine may be particularly beneficial for specific populations of patients with MDD, including those with treatment-emergent sexual dysfunction and patients experiencing certain cognitive symptoms. Given these recent label updates, this prescribing guide for vortioxetine aims to provide clear and practical guidance for primary care clinicians on the safe and effective use of vortioxetine for the treatment of MDD, including how to identify appropriate patients for treatment.
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Affiliation(s)
- C Brendan Montano
- Montano Wellness LLC, Cromwell, CT, USA.,Department of Family Medicine, University of Connecticut Medical School, Farmington, CT, USA
| | - W Clay Jackson
- Department of Psychiatry and Family Medicine, West Cancer Center, Germantown, TN, USA.,Department of Psychiatry and Family Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
| | - Denise Vanacore
- Department of Nursing, Messiah University, Mechanicsburg, PA, USA
| | - Richard H Weisler
- Richard H. Weisler MD, P.A. & Associates, Raleigh, NC, USA.,Department of Psychiatry, Duke University and the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Safarini OA, Taya H, Abu Elhija Y, Qadous M, Farhoud A, Thabaleh A, Khayyat A, Nazzal Z, Abuhassan AM, Ghanim N, Mahamid F, Al Ali R, Damiri B. Assessment of the Relationship of Depression With Tobacco and Caffeine Use Among University Students: A Cross-Sectional Study. Cureus 2021; 13:e19098. [PMID: 34868751 PMCID: PMC8627153 DOI: 10.7759/cureus.19098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background University students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in the last decade. However, depression among tobacco and caffeine users remains underrecognized and neglected. Methodology A self-administrated questionnaire and the Beck Depression Inventory were used to assess the association of depression and the use of cognitive enhancers and psychoactive substances among university students at An-Najah National University in 2020. Results The response rate to the questionnaires was 78.8% (n = 1,051; 38.8% males, 61.2% females). The overall prevalence of depression was high (30.6% males, 34.7% females). The prevalence of cigarette smoking (39.2% males, 3.9% females), waterpipe smoking (43.1% males, 21.6% females), energy drink consumption (59.6% males, 29.7% females), coffee consumption (85.5% for each gender), tea consumption, and chocolate consumption was high, with significant differences in accordance to gender and academic fields. The multinomial logistic regression results revealed that cigarette smokers were more likely to have a higher risk of severe (odds ratio [OR] = 4.5, p = 0.001), moderate (OR = 3.27, p < 0.001), and mild depression (OR = 2.24, p = 0.002) than non-smokers. Severe depression was less prevalent among medical students than health sciences and non-medical students (OR = 0.215, p = 0.015). Moreover, males were less likely to have moderate (OR = 0.5, p = 0.012) and mild (OR = 0.48, p = 0.001) depression than females. Conclusions Overall, the results of this study revealed the high prevalence of depression and the detrimental effects of smoking on students. Moreover, the findings suggest the urgent need to address depression and risk factors among Palestinian university students by educating them about mental health, identifying high-risk students, and offering easily accessible psychological help. Further, it is crucial to broaden the focus of studies to include students from various academic fields instead of focusing on medical students.
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Affiliation(s)
| | | | | | - Marah Qadous
- Medicine, An-Najah National University, Nablus, PSE
| | | | | | | | - Zaher Nazzal
- Community and Family Medicine, An-Najah National University, Nablus, PSE
| | | | - Nesma Ghanim
- Medicine, An-Najah National University, Nablus, PSE
| | - Fayez Mahamid
- Clinical Psychology, An-Najah National University, Nablus, PSE
| | - Rayyan Al Ali
- Forensic Medicine, An-Najah National University, Nablus, PSE
| | - Basma Damiri
- Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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16
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Nguyen MD, Nguyen QV, Ha CD, Van Tran T, Dang LVP. Beneficial Effects of Acupuncture as a Complementary Treatment for Patients Receiving Paroxetine For Major Depressive Disorder: A Meta-Analysis. Med Acupunct 2021; 33:420-427. [PMID: 34976275 DOI: 10.1089/acu.2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Major depressive disorder (MDD) is a major public health problem due to MDD's increasing incidence among adults worldwide. While selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, are considered to be the most effective treatment for MDD, the adverse effects of SSRIs should not be neglected. The aim of this research was to evaluate the effectiveness of acupuncture as a complement to paroxetine systematically for improving quality of life (QoL) for patients with MDD. Methods and Materials: Chinese and English electronic databases were searched, randomized controlled clinical studies were collected, data entry was managed, and a meta-analysis was performed to evaluate the QoL of the patients pre and post treatment. Results: There were 5 studies included in the review, in which the researchers compared the QoL of patients with MDD treated with: paroxetine + acupuncture (both electroacupuncture and traditional acupuncture) or paroxetine alone. In all aspects-including physical health, psychologic health, social relationships, and environment-patients treated with the combination therapy experienced a significant improvements in QoL compared the patients treated with the single therapy. Conclusions: Using acupuncture as a complementary treatment improved QoL in patients with MDD.
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Affiliation(s)
- Minh Duc Nguyen
- Senior Specialist Clinic, National Hospital of Acupuncture, Hanoi, Vietnam
| | - Quoc Vinh Nguyen
- Department of Senior Specialist, Military Institute of Traditional Medicine, Hanoi, Vietnam
| | - Cay Doan Ha
- Department of Minimally Invasive Spine, National Hospital of Acupuncture, Hanoi, Vietnam
| | - Thanh Van Tran
- Senior Specialist Clinic, National Hospital of Acupuncture, Hanoi, Vietnam
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17
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Functional gastrointestinal disorders as predictors of suicidal ideation. An observational study. Eur J Gastroenterol Hepatol 2021; 33:e758-e765. [PMID: 34231520 DOI: 10.1097/meg.0000000000002245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Suicidal ideation (SI), a symptom of depression, is known to be associated with irritable bowel syndrome (IBS) but is not known to be associated with other functional gastrointestinal disorders (FGIDs). However, the source of this association is discussed. It could be related to a possible abnormal biochemical pathway implicating neurotransmitters common to both disorders like serotonin or pain and an ill-being associated with a chronic disorder of unknown etiology. The present study aims to search for the FGIDs associated with suicidal ideation. DESIGN Observational study. METHODS A total of 1469 patients with FGIDs (71% of women) were included in the present study. They filled the Rome III questionnaire, Beck depression inventory, and state and trait anxiety questionnaires. Data were analyzed using analysis of variance with Bonferroni correction and logistic regression analysis. RESULTS Suicidal ideation was reported by 15% of patients, associated with increased scales of depression (P < 0.001), state (P = 0.006), and trait anxiety (P = 0.021). Clinically, these patients reported a higher prevalence of IBS-diarrhea subtype (P = 0.045), fecal incontinence (P = 0.020), soiling (P = 0.016), and difficult defecation (P = 0.005), and higher perceived severity for constipation, diarrhea, bloating, and abdominal pain (P < 0.001 for all scales). CONCLUSIONS This study shows that only functional bowel and functional anorectal disorders are associated with suicidal ideation. This result must be taken into account in the management of these patients.
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18
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Pandey GN, Sharma A, Rizavi HS, Ren X. Dysregulation of Protein Kinase C in Adult Depression and Suicide: Evidence From Postmortem Brain Studies. Int J Neuropsychopharmacol 2021; 24:400-408. [PMID: 33515455 PMCID: PMC8130206 DOI: 10.1093/ijnp/pyab003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several lines of evidence suggest the abnormalities of protein kinase C (PKC) signaling system in mood disorders and suicide based primarily on the studies of PKC and its isozymes in the platelets and postmortem brain of depressed and suicidal subjects. In this study, we examined the role of PKC isozymes in depression and suicide. METHODS We determined the protein and mRNA expression of various PKC isozymes in the prefrontal cortical region (Brodmann area 9) in 24 normal control subjects, 24 depressed suicide (DS) subjects, and 12 depressed nonsuicide (DNS) subjects. The levels of mRNA in the prefrontal cortex were determined by quantitative real-time reverse transcription PCR, and the protein expression was determined by western blotting. RESULTS We observed a significant decrease in mRNA expression of PKCα, PKCβI, PKCδ, and PKCε and decreased protein expression in either the membrane or the cytosol fraction of PKC isozymes PKCα, PKCβI, PKCβII, and PKCδ in DS and DNS subjects compared with normal control subjects. CONCLUSIONS The current study provides detailed evidence of specific dysregulation of certain PKC isozymes in the postmortem brain of DS and DNS subjects and further supports earlier evidence for the role of PKC in the platelets and brain of the adult and teenage depressed and suicidal population. This comprehensive study may lead to further knowledge of the involvement of PKC in the pathophysiology of depression and suicide.
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Affiliation(s)
- Ghanshyam N Pandey
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA,Correspondence: Ghanshyam N. Pandey, PhD, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, USA ()
| | - Anuradha Sharma
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Hooriyah S Rizavi
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Xinguo Ren
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
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19
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Wu Q, Li J, Parrott S, López-López JA, Davies SR, Caldwell DM, Churchill RC, Peters TJ, Lewis G, Tallon D, Dawson S, Taylor A, Kessler DS, Wiles N, Welton NJ. Cost-Effectiveness of Different Formats for Delivery of Cognitive Behavioral Therapy for Depression: A Systematic Review Based Economic Model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1662-1670. [PMID: 33248522 DOI: 10.1016/j.jval.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Cognitive behavioral therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face [F2F], multimedia, and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes. METHODS A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment as usual (TAU). The model covered an average treatment period of 4 months with a 5-year follow-up period. The model was populated using a systematic review of randomized controlled trials and various sources from the literature. RESULTS Incremental cost-effectiveness ratios of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/quality-adjusted life year (QALY) for 6 (sessions) × 30 (minutes) F2F-CBT versus TAU; £4 453/QALY for 8 × 30 F2F versus 6 × 30 F2F; £12 216/QALY for 8 × 60 F2F versus 8 × 30 F2F; and £43 072/QALY for 16 × 60 F2F versus 8 × 60 F2F. The treatment with the highest net monetary benefit for thresholds of £20 000 to £30 000/QALY was 8 × 30 F2F-CBT. Probabilistic sensitivity analysis illustrated 6 × 30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20 000/QALY; 16 × 60 F2F-CBT had the highest probability (31.0%) at £30 000/QALY. CONCLUSIONS All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6 × 30, 8 × 30, 8 × 60, 16 × 60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6 × 30 and 16 × 60 had the highest probabilities of being cost-effective. The results, however, should be interpreted with caution owing to the high level of uncertainty.
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Affiliation(s)
- Qi Wu
- Department of Health Sciences, University of York, Heslington, York, England, UK.
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, England, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, England, UK
| | | | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, England, UK
| | - Deborah M Caldwell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Rachel C Churchill
- Centre for Reviews and Dissemination, University of York, York, England, UK
| | - Tim J Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Debbie Tallon
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Sarah Dawson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Abigail Taylor
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - David S Kessler
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Nicky J Welton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
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21
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Chesebro J, Armes K, Peterson K. Focus on pharmacotherapy for depression. Nursing 2019; 49:32-39. [PMID: 31658229 DOI: 10.1097/01.nurse.0000604708.27955.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many patients are prescribed antidepressants. This article discusses depression, as well as the available first- and second-line prescription medications used to manage the disorder in adults.
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Affiliation(s)
- Jennifer Chesebro
- At the College at Brockport, State University of New York, Jennifer Chesebro is an instructor and Kathleen Peterson is a professor. Katelyn Armes is a pharmacist at CVS Pharmacy
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22
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The future of population medicine: Investigating the role of advanced practice providers and simulation education in special patient populations. Dis Mon 2018; 65:221-244. [PMID: 30583793 DOI: 10.1016/j.disamonth.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advanced practice providers (APPs) have come to play an increasingly significant role in the United States healthcare system in the past five decades, particularly in primary care. The first portion of this paper will explore the utilization of APPs in specific patient populations: pediatrics, obstetrics, geriatrics, and psychiatry. After a brief discussion of the demand for these specialties, the authors will outline the educational preparation and competencies that nurse practitioners and physician assistants must achieve before working with these special populations. Finally, the authors will discuss the current and future roles of APPs in pediatric, obstetric, geriatric, and psychiatric populations. Simulated patient interactions and scenarios have become integrated into clinical education for many health care providers. Although traditionally utilized only in emergency medicine education, medical simulation has grown to become a staple of training in nearly every area of medicine. Healthcare providers of all levels can benefit from both individual and team-based training designed to improve everything from patient communication to procedural competence. The flexible nature of simulation training allows for customized teaching that is directly relevant to a specific specialty. The second half of this paper will demonstrate simulation's versatilite applications in the specialty areas of urgent care, pediatrics, mental health, geriatrics, and obstetrics.
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23
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Habs M, Binder K, Krauss S, Müller K, Ernst B, Valentini L, Koller M. A Balanced Risk-Benefit Analysis to Determine Human Risks Associated with Pyrrolizidine Alkaloids (PA)-The Case of Herbal Medicinal Products Containing St. John's Wort Extracts (SJW). Nutrients 2018; 10:E804. [PMID: 29932143 PMCID: PMC6073194 DOI: 10.3390/nu10070804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Pyrrolizidine alkaloids (PA) exist ubiquitously in our environment. More than 6000 plants, about 3% of the world’s flowering plants, are known to synthesize PA. As a consequence, many herbal ingredients, including St. John’s wort (SJW), are contaminated with PA that can possess acute and subchronic toxic effects as well as mutagenic and genotoxic properties. Therefore, the possible benefits of SJW as an herbal remedy against depression need to be weighed against the possible risks of unwanted PA intake. METHODS We searched the literature regarding the current knowledge on PA and evaluated the evidence on the antidepressant effects of quantified SJW extract based on a Cochrane Review and the current practice guidelines on depression. Risks are depicted in form of a risk ladder and benefits in form of an icon array. RESULTS Evidence from clinical studies indicates that quantified SJW extract is an effective treatment option for mild to moderate depression with fewer side effects than conventional antidepressants. Health statistics from different countries do not quantify cases of death caused by PA intake. However, deaths due to suicide, often triggered by depression, are common (11 in 1000 in Germany in 2015) and rank between fatalities due to liver diseases (16 in 1000) and household accidents (10 in 1000). CONCLUSIONS Quantified SJW extract is a safe and effective treatment option, and its potential of treating depression outweighs the (hypothetical) risk of unwanted PA intake.
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Affiliation(s)
- Michael Habs
- Faculty of Medicine, LMU-University of Munich, 80336 Munich, Germany.
| | - Karin Binder
- Didactics of Mathematics, University of Regensburg, 93053 Regensburg, Germany.
| | - Stefan Krauss
- Didactics of Mathematics, University of Regensburg, 93053 Regensburg, Germany.
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany.
| | - Brigitte Ernst
- General Medicine Unit, University Hospital Regensburg, 93053 Regensburg, Germany.
| | - Luzia Valentini
- Institute of Evidence-Based Dietetics, University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany.
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany.
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Abstract
Major depression is common in the primary care setting. In the final article of this series, we illustrate the approach to the management of depression in primary care. Psychotherapy has been shown to be as effective as antidepressants for mild to moderate major depression. The common myth that antidepressants are addictive should be addressed. Antidepressants should be started at a subtherapeutic dose to assess tolerability, then gradually increased until a minimally effective dose is achieved. Apart from pharmacotherapy and psychotherapy, management of depression should include managing stressors, engaging social and community support, dealing with stigma and discrimination, and managing concomitant comorbidities. A strong therapeutic relationship and empathic listening are important between the primary care physician and patient.
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Affiliation(s)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
| | - Yin Ping Ng
- Penang Medical College, Penang, Malaysia.,Penang Adventist Hospital, Penang, Malaysia
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