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Belzeaux R, Gressier F, Boudieu L, Arnould A, Moreau E, Pastol J, Tzavara E, Sutter-Dallay AL, Samalin L. French Society for Biological Psychiatry and Neuropsychopharmacology and French-speaking Marcé Society guidelines for the management of mood disorders in women before, during, and after pregnancy. Arch Womens Ment Health 2024; 27:595-605. [PMID: 38367037 DOI: 10.1007/s00737-024-01440-6] [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: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The French Society for Biological Psychiatry and Neuropsychopharmacology and the French-speaking Marcé Society have joined forces to establish expert recommendations on the prescription of psychotropic drugs before, during, and after pregnancy in women with major depressive disorder (MDD) and bipolar disorder (BD). METHODS To elaborate recommendations, we used the RAND/UCLA Appropriateness Method, which combines scientific evidence and expert clinicians' opinions. A written survey was completed by 48 psychiatrists, who have expertise in the management of mood disorders and/or in perinatal psychiatry. Key recommendations are provided by the scientific committee based on data analysis and interpretation of the results of the survey. RESULTS The recommendations address the following three areas that are deemed essential in women with mood disorders, with an emphasis on screening, treatment options, and monitoring: (i) management of mood disorders in women of childbearing age, (ii) management during pregnancy, (iii) management during the post-partum period. As first-line strategies, experts recommend treating mood symptoms during pregnancy and maintaining a pharmacological treatment, even in euthymic or stabilized patients. First-line options include only medications with no teratogenic risk, and during breastfeeding, only medications without evidence of adverse effects in nursing infants. CONCLUSION The expert consensus guidelines will help facilitate treatment decisions for clinicians in the daily assessment and management of mood disorders in women of childbearing age, during pregnancy, and in the post-partum period.
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Affiliation(s)
- Raoul Belzeaux
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France.
- Pôle Universitaire de Psychiatrie, CHU de Montpellier, 39 Avenue C. Flahaut, 34090, Montpellier, France.
| | - Florence Gressier
- Société Marcé Francophone, Chatenay Malabry, France
- Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Université Paris-Saclay, Equipe Moods, INSERM, UMR-1018, CESP, Le Kremlin Bicêtre, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, (UMR 6602), Clermont-Ferrand, France
| | - Adeline Arnould
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, (UMR 6602), Clermont-Ferrand, France
| | - Elsa Moreau
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Julia Pastol
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Eleni Tzavara
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
- Université Paris Cité, CNRS, UMR 8002 INCC, Paris, France
| | - Anne Laure Sutter-Dallay
- Société Marcé Francophone, Chatenay Malabry, France
- BPHRC INSERM 1219, HEALTHY Team, Bordeaux University, Bordeaux, France
- Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Ludovic Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, (UMR 6602), Clermont-Ferrand, France
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Nygren A, Brenner P, Brandt L, Karlsson P, Eloranta S, Reutfors J. Trends in hypnotic drug use in depression 2007-2017: A Swedish population-based study. J Sleep Res 2024:e14267. [PMID: 38874288 DOI: 10.1111/jsr.14267] [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: 06/16/2023] [Revised: 03/01/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Insomnia is a common feature of depression; however, depression treatment guidelines provide limited recommendations regarding hypnotic drugs. Few studies have thoroughly investigated the use of hypnotic drugs in depression. In this cohort study using national Swedish registers, we included all patients ≥18 years with incident unipolar depression during 2007-2017. Patients were followed for 3 years, noting the annual and quarterly prevalence of hypnotic drug use from prescription fills. Prevalence ratios (PR) comparing 2017 to 2007 were calculated with 95% confidence intervals (CI). A total of 222,077 patients with depression were included (mean age 41 years, 59% women). In the year following diagnosis, 44.1% used any hypnotic drug in 2017, compared with 46.7% in 2007 (PR 0.94, 95% CI 0.92-0.97). The most commonly used drugs were Z-drugs (zopiclone, zolpidem, and zaleplon) with a prevalence of 27.6% in 2017 and 35.6% in 2007 (PR 0.78, 95% CI 0.75-0.80). Melatonin use increased sharply to 12.0% in 2017 from 0.4% in 2007 (PR 28.9, 95% CI 23.5-35.7). Hypnotic drug use was most prevalent in the first two quarters after diagnosis; however, after 3 years, the quarterly prevalence was still 19.2%. Hypnotics were more common among women, older patients, those with somatic comorbidities, more severe depression, or a history of suicide attempt. Evidence from this large register-based study demonstrates that hypnotics were used to a large extent in depression in Sweden 2007-2017. Z-drugs use declined and melatonin use increased dramatically. Hypnotic drug use remained high even 3 years after diagnosis.
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Affiliation(s)
- Adam Nygren
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - P Brenner
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - L Brandt
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - P Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - J Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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Pedraz-Petrozzi B, Sardinha H, Gilles M, Deuschle M. Effects of left anodal transcranial direct current stimulation on hypothalamic-pituitary-adrenal axis activity in depression: a randomized controlled pilot trial. Sci Rep 2023; 13:5619. [PMID: 37024593 PMCID: PMC10079657 DOI: 10.1038/s41598-023-32531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The main objective of this study was to evaluate the effect of left anodal transcranial direct current stimulation (tDCS) on hypothalamic-pituitary-adrenal axis (HPAA) activity in individuals with depression. We conducted a 3-week, randomized, triple-blind pilot trial with 47 participants (dropout rate: 14.89%) randomly assigned to either the tDCS or control group (sham stimulation). Salivary cortisol was used as an HPAA activity marker since cortisol is the effector hormone of the HPAA. The primary outcome was the effect of tDCS on the diurnal cortisol pattern (DCP and area under the curve with respect to ground -AUCg-). Secondary outcomes included tDCS effects on cortisol awakening response (CAR) and cortisol decline (CD), as well as the variation of cortisol concentrations between the initiation of tDCS and 2 weeks later. Intention-to-treat and per-protocol analyses were conducted. Our primary outcome showed an absent effect of tDCS on DCP and AUCg. Additionally, tDCS had an absent effect on CAR, CD, and cortisol concentration variation before-after stimulation. Our pilot study suggests that anodal tDCS showed an absent effect on HPAA activity in individuals with depression. More studies are needed to confirm these findings.
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Affiliation(s)
- Bruno Pedraz-Petrozzi
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Helena Sardinha
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
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Xue L, Shao J, Wang H, Wang X, Zhu R, Yao Z, Lu Q. Shared and unique imaging-derived endo-phenotypes of two typical antidepressant-applicative depressive patients. Eur Radiol 2022; 33:645-655. [PMID: 35980436 DOI: 10.1007/s00330-022-09004-x] [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: 03/01/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Determining the clinical homogeneous and heterogeneous sets among depressive patients is the key to facilitate individual-level treatment decision. METHODS The diffusion tensor imaging (DTI) data of 62 patients with major depressive disorder (MDD) and 39 healthy controls were used to construct a Latent Dirichlet Allocation (LDA) Bayesian model. Another 48 MDD patients were used to verify the robustness. The LDA model was employed to identify both shared and unique imaging-derived factors of two typically antidepressant-targeted depressive patients, selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Furthermore, we applied canonical correlation analysis (CCA) between each factor loading and Hamilton depression rating scale (HAMD) sub-score, to explore the potential neurophysiological significance of each factor. RESULTS The results revealed the imaging-derived connectional fingerprint of all patients could be situated along three latent factor dimensions; such results were also verified by the out-of-sample dataset. Factor 1, uniquely expressed by SNRI-targeted patients, was associated with retardation (r = 0.4, p = 0.037) and characterized by coupling patterns between default mode network and cognitive control network. Factor 3, uniquely expressed by SSRI-targeted patients, was associated with cognitive impairment (r = 0.36, p = 0.047) and characterized by coupling patterns within cognitive control and attention network, and the connectivity between threat and reward network. Shared factor 2, characterized by coupling patterns within default mode network, was associated with anxiety (r = 0.54, p = 0.005) and sleep disturbance (r = 0.37, p = 0.032). CONCLUSIONS Our findings suggested that quantification of both homogeneity and heterogeneity within MDD may have the potential to inform rational design of pharmacological therapies. KEY POINTS • The shared and unique manifestations guiding pharmacotherapy of depressive patients are caused by the homogeneity and heterogeneity of underlying structural connections of the brain. • Both shared and unique factor loadings were found in different antidepressant-targeted patients. • Significant correlations between factor loading and HAMD sub-scores were found.
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Affiliation(s)
- Li Xue
- School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, Jiangsu Province, 210096, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Junneng Shao
- School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, Jiangsu Province, 210096, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Huan Wang
- School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, Jiangsu Province, 210096, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Xinyi Wang
- School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, Jiangsu Province, 210096, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Rongxin Zhu
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China. .,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China.
| | - Qing Lu
- School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, Jiangsu Province, 210096, China. .,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China.
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Effects of Mood Regulation on Sociodemographic Status, Exercise Pattern, and Physical Conditions of Chinese Adults and the Elderly. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2034957. [PMID: 35832131 PMCID: PMC9273414 DOI: 10.1155/2022/2034957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
Objective This study focused on mood regulations and their association with sociodemographic status, exercise pattern, and physical conditions of adults and older adults in China who did not undergo interventions. Method Data were based on the 2016 to 2018 Guangdong National Physique Monitoring data, in which 5242 participants aged 20-69 years were recruited. Multiple statistical analysis methods, such as descriptive and logistic regression analyses, were used to study each exercise motivation and its association with influencing factors, including sociodemographic characteristics, exercise measurements, and physical conditions. An exercise index for mental health was also used to investigate the number and types of people who were more likely to meet the index. Results We observed that 44.9% (2355/5242) of participants did not engage in physical exercise in this study. Only older participants (40 to 69 years old) and those with an average level of education (high school/technical secondary school) showed a significant association with exercising for mood regulation. Few people met the index that is good for mental health (16.64% [872/5242] met index 1, and 2.84% (149/5242) met index 2), and higher education showed a significant association with a reduction in the mental health burden and the prevention of depression. Conclusion This study found that motivating people to be more active and educating them on the potential mental health benefits of exercise could help them to exercise more.
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Xu T, Gao N, Li Y, Wang R, Chen B, Hu G, Zhang X. Inhibitory effects of fluoxetine and duloxetine on the pharmacokinetics of metoprolol in vivo and in vitro. Fundam Clin Pharmacol 2022; 36:1057-1065. [PMID: 35510497 DOI: 10.1111/fcp.12795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 12/01/2022]
Abstract
Depression is common among people with cardiovascular diseases. Therefore, the combined use of antidepressants and cardiovascular drugs is very common, which increases the possibility of drug interaction. Simultaneously compare the effects of duloxetine and fluoxetine on metoprolol metabolism, and provide evidence-based guidance for medication safety. Sprague-Dawley rats were randomly divided into three groups: group A (10.3 mg/kg metoprolol alone), group B (10.3 mg/kg metoprolol + 6.2 mg/kg fluoxetine), and group C (10.3 mg/kg metoprolol + 6.2 mg/kg duloxetine). Tail vein blood was collected and subjected to the ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) detection. Moreover, in vitro inhibition of fluoxetine and duloxetine were assessed by incubating liver microsomes and CYP2D6.1 with metoprolol. In in vivo study, the administration of fluoxetine or duloxetine significantly increased the AUC(0-𝑡) and AUC(0-∞) of metoprolol (P < 0.05). Differences between fluoxetine and duloxetine in plasma concentration were also investigated, and their pharmacokinetic parameters such as AUC(0-𝑡) and AUC(0-∞) were significantly distinct (P < 0.05). In vitro, fluoxetine and duloxetine inhibited the metabolism of metoprolol via mixed competitive mechanism of cytochrome P450. IC50 values of fluoxetine and duloxetine were 12.86 and 2.51 μM, respectively. Moreover, the metabolism rate of metoprolol was inhibited to 19.62% and 17.14% in recombinant human CYP2D6.1 by fluoxetine and duloxetine, respectively. Duloxetine showed a more significant inhibitory potential compared to fluoxetine in vitro, but the main pharmacokinetic parameters of fluoxetine and duloxetine revealed differences in inhibiting metoprolol metabolism in vivo.
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Affiliation(s)
- Tao Xu
- Department of Pharmacy, Ningbo City First Hospital, Ningbo, Zhejiang, China
| | - Nanyong Gao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yinghui Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ru Wang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bingbing Chen
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guoxin Hu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaodan Zhang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Pharmacy, The Seventh People's Hospital of Wenzhou, Wenzhou, Zhejiang, China
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Reangsing C, Wimolphan P, Wongsuraprakit S, Oerther S. Effects of Mindfulness-Based Interventions on Depressive Symptoms and Alcohol Craving in Individuals With Comorbid Alcohol Use Disorder and Depression: A Systematic Review. J Psychosoc Nurs Ment Health Serv 2021; 59:41-47. [PMID: 34432591 DOI: 10.3928/02793695-20210819-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The co-occurrence of alcohol use disorder (AUD) and depression is associated with a seven-fold increased risk of suicide. The purpose of the current systematic review is to synthesize the evidence of the effectiveness of mindfulness-based interventions (MBIs) on depression and alcohol craving in patients with comorbid AUD and depression. Electronic databases were searched using a combination of key words. Seven studies, investigating a total of 349 participants, were included. MBIs improved depression and alcohol craving among individuals with comorbid AUD and depression. Health care professionals can use MBI as adjunctive treatment for decreasing depression and alcohol craving. Future research is needed to explore how MBIs can be tailored to specific cultures and to document the longitudinal effectiveness of treatment. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Kasper S, Cubała WJ, Fagiolini A, Ramos-Quiroga JA, Souery D, Young AH. Practical recommendations for the management of treatment-resistant depression with esketamine nasal spray therapy: Basic science, evidence-based knowledge and expert guidance. World J Biol Psychiatry 2021; 22:468-482. [PMID: 33138665 DOI: 10.1080/15622975.2020.1836399] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Despite the available therapies for treatment-resistant depression (TRD), there are a limited number that are evidence-based and effective in this hard-to-treat population. Esketamine nasal spray, an intranasal N-methyl-d-aspartate (NMDA) glutamate receptor antagonist, is a novel, fast-acting option in this patient population. This manuscript provides expert guidance on the practicalities of using esketamine nasal spray. METHODS A group of six European experts in major depressive disorder (MDD) and TRD, with clinical experience of treating patients with esketamine nasal spray, first generated practical recommendations, before editing and voting on these to develop consensus statements during an online meeting. RESULTS The final consensus statements encompass not only pre-treatment considerations for patients with TRD, but also specific guidelines for clinicians to consider during and post-administration of esketamine nasal spray. CONCLUSIONS Esketamine nasal spray is a novel, fast-acting agent that provides an additional treatment option for patients with TRD who have previously failed several therapies. The guidance here is based on the authors' experience and the available literature; however, further real-world use of esketamine nasal spray will add to existing knowledge. The recommendations offer practical guidance to clinicians who are unfamiliar with esketamine nasal spray.
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Affiliation(s)
- Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Wiesław J Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Josep A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Souery
- European Centre of Psychological Medicine, Psy Pluriel, Brussels, Belgium
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
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Yrondi A, Arbus C, Bennabi D, D’Amato T, Bellivier F, Bougerol T, Camus V, Courtet P, Doumy O, Genty JB, Holtzmann J, Horn M, Lancon C, Leboyer M, Llorca PM, Maruani J, Moirand R, Molière F, Petrucci J, Richieri R, Samalin L, Stephan F, Vaiva G, Walter M, Haffen E, Aouizerate B, El-Hage W. Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population. PLoS One 2021; 16:e0250148. [PMID: 33878137 PMCID: PMC8057608 DOI: 10.1371/journal.pone.0250148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction We assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample. Methods Patients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres. Results Our sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k2 = 0.191) and 16% (k2 = 0.16), respectively for the two scales, indicate a moderate effect. Conclusion To our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms.
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Affiliation(s)
- Antoine Yrondi
- Fondation FondaMental, Creteil, France
- Service de Psychiatrie et de Psychologie Médicale de l’adulte (Department of Psychiatry and Adult Medical Psychology), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression, CHU de Toulouse (University Hospital Centre), Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), INSERM, UPS, Toulouse, France
- * E-mail:
| | - Christophe Arbus
- Fondation FondaMental, Creteil, France
- Service de Psychiatrie et de Psychologie Médicale de l’adulte (Department of Psychiatry and Adult Medical Psychology), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression, CHU de Toulouse (University Hospital Centre), Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), INSERM, UPS, Toulouse, France
| | - Djamila Bennabi
- Fondation FondaMental, Creteil, France
- Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, Université de Bourgogne Franche Comté, Besançon, France
| | - Thierry D’Amato
- Fondation FondaMental, Creteil, France
- INSERM U1028; CNRS UMR5292; University Lyon 1, Villeurbanne, F-69000, France; Lyon Neuroscience Research Centre; Psychiatric Disorders: From Resistance to Response ΨR2 Team; Centre Hospitalier Le Vinatier (Hospital Centre); Bron, France
| | - Frank Bellivier
- Fondation FondaMental, Creteil, France
- AP-HP, GH Saint-Louis—Lariboisière—Fernand Widal, Pôle Neurosciences Tête et Cou (Head and Neck Neurosciences Cluster), University Paris Diderot, Paris, France
| | - Thierry Bougerol
- Fondation FondaMental, Creteil, France
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences (Institute of Neurosciences), Grenoble, France
| | - Vincent Camus
- Fondation FondaMental, Creteil, France
- U1253, iBrain, CIC1415, Inserm, CHRU de Tours (Regional University Hospital Centre), Université de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental, Creteil, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Olivier Doumy
- Fondation FondaMental, Creteil, France
- Pôle de Psychiatrie Générale et Universitaire (General and University Psychiatry Cluster), Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux (Bordeaux University), Bordeaux, France
| | - Jean-Baptiste Genty
- Fondation FondaMental, Creteil, France
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Jérôme Holtzmann
- Fondation FondaMental, Creteil, France
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences (Institute of Neurosciences), Grenoble, France
| | - Mathilde Horn
- Fondation FondaMental, Creteil, France
- Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Christophe Lancon
- Fondation FondaMental, Creteil, France
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Marion Leboyer
- Fondation FondaMental, Creteil, France
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Creteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Julia Maruani
- Fondation FondaMental, Creteil, France
- AP-HP, GH Saint-Louis—Lariboisière—Fernand Widal, Pôle Neurosciences Tête et Cou (Head and Neck Neurosciences Cluster), University Paris Diderot, Paris, France
| | - Rémi Moirand
- Fondation FondaMental, Creteil, France
- INSERM U1028; CNRS UMR5292; University Lyon 1, Villeurbanne, F-69000, France; Lyon Neuroscience Research Centre; Psychiatric Disorders: From Resistance to Response ΨR2 Team; Centre Hospitalier Le Vinatier (Hospital Centre); Bron, France
| | - Fanny Molière
- Fondation FondaMental, Creteil, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Jean Petrucci
- Fondation FondaMental, Creteil, France
- Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Raphaelle Richieri
- Fondation FondaMental, Creteil, France
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Ludovic Samalin
- Fondation FondaMental, Creteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Florian Stephan
- Fondation FondaMental, Creteil, France
- Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psychosocial Rehabilitation), Centre Expert Depression Résistante FondaMental, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Guillaume Vaiva
- Fondation FondaMental, Creteil, France
- Centre National de Ressources et Résilience pour les psychotraumatisme (National Resilience and Resources Centre for Psychological Trauma), Lille, France
| | - Michel Walter
- Fondation FondaMental, Creteil, France
- Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psychosocial Rehabilitation), Centre Expert Depression Résistante FondaMental, CHRU de Brest, Hôpital de Bohars, Brest, France
| | | | - Emmanuel Haffen
- Fondation FondaMental, Creteil, France
- Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, Université de Bourgogne Franche Comté, Besançon, France
| | - Bruno Aouizerate
- Fondation FondaMental, Creteil, France
- Pôle de Psychiatrie Générale et Universitaire (General and University Psychiatry Cluster), Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux (Bordeaux University), Bordeaux, France
| | - Wissam El-Hage
- Fondation FondaMental, Creteil, France
- U1253, iBrain, CIC1415, Inserm, CHRU de Tours (Regional University Hospital Centre), Université de Tours, Tours, France
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10
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Treatment-Resistant Depression in a Real-World Setting: First Interim Analysis of Characteristics, Healthcare Resource Use, and Utility Values of the FondaMental Cohort. Brain Sci 2020; 10:brainsci10120962. [PMID: 33321879 PMCID: PMC7764571 DOI: 10.3390/brainsci10120962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Major depressive disorder (MDD) is among the most common psychiatric disorders. One-third of patients are usually unresponsive to several lines of treatment. This study aimed to describe the FondaMental French cohort of patients with treatment-resistant depression (TRD) and to estimate utility and healthcare resource use outcomes. Methods: Patients with TRD were evaluated prospectively over four years (baseline, 6, 12, 18, 24, 36 and 48 months) in a real-world clinical setting. Interim analyses focused on the first two consecutive years. Four MDD-related states (major depressive episode (MDE), response, remission, recovery) were defined based on the MADRS (Montgomery–Åsberg depression rating scale) and other clinical events. Health status was assessed with the EuroQol 5 Dimensions 5 Level (EQ-5D-5L) questionnaire. Utility values were estimated as preference measures that the patients assigned to their overall health status. Results: This study was based on 252 patients with TRD. The mean utility value by health state was 0.41, 0.63, 0.80, and 0.90, for MDE, response, remission, and recovery, respectively. At baseline, 59% of patients had an MADRS score of at least 28. Their baseline average utility value was lower compared to the other patients (0.43 versus 0.58, p < 0.001). This significant difference persisted at the following visits. The rate of patients in MDEs having at least one hospitalisation for depression or other reasons than depression was generally higher than that in the other health states. Conclusion: This study documented patterns in healthcare resource consumption, quality of life, and other characteristics in patients with TRD, both globally and by health state and depression severity.
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Rifkin-Zybutz R, MacNeill S, Davies SJC, Dickens C, Campbell J, Anderson IM, Chew-Graham CA, Peters TJ, Lewis G, Wiles N, Kessler D. Does anxiety moderate the effectiveness of mirtazapine in patients with treatment-resistant depression? A secondary analysis of the MIR trial. J Psychopharmacol 2020; 34:1342-1349. [PMID: 33143538 PMCID: PMC7708671 DOI: 10.1177/0269881120965939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a lack of evidence to guide treatment of comorbid depression and anxiety. Preliminary evidence suggests mirtazapine may be effective in treating patients with both depression and anxiety symptoms. METHODS We undertook a secondary analysis of mirtazapine (MIR): a placebo-controlled trial of the addition of mirtazapine to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor in treatment-resistant depression (TRD) in primary care. We subdivided participants into three groups by baseline generalized anxiety disorder score (GAD-7): severe (GAD-7 ⩾ 16), moderate (GAD-7 = 11-15), no/mild (GAD-7 ⩽ 10). We used linear regression including likelihood-ratio testing of interaction terms to assess how baseline anxiety altered the response of participants to mirtazapine as measured by 12-week GAD-7 and Beck Depression Inventory II (BDI-II) scores. RESULTS Baseline generalized anxiety moderated mirtazapine's effect as measured by GAD-7 (p = 0.041) and BDI-II (p = 0.088) at 12 weeks. Participants with severe generalized anxiety receiving mirtazapine had lower 12-week GAD-7 score (adjusted difference between means (ADM) -2.82, 95% confidence interval (CI) -0.69 to -4.95) and larger decreases in BDI-II score (ADM -6.36, 95% CI -1.60 to -10.84) than placebo. Conversely, there was no anxiolytic benefit (ADM 0.28, 95% CI -1.05 to 1.60) or antidepressant benefit (ADM -0.17, 95% CI -3.02 to 2.68) compared with placebo in those with no/mild generalized anxiety. CONCLUSIONS These findings extend the evidence for the effectiveness of mirtazapine to reduce generalized anxiety in TRD in primary care. These results may inform targeted prescribing in depression based on concurrent anxiety symptoms, although these conclusions are constrained by the post-hoc nature of this analysis.
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Affiliation(s)
- Raphael Rifkin-Zybutz
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK,Raphael Rifkin-Zybutz, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House Bristol, Bristol, BS8 2BN, UK.
| | - Stephanie MacNeill
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon JC Davies
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | | | - John Campbell
- Academic Primary Care, University of Exeter, Exeter, UK
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | | | - Tim J Peters
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Kessler
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
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Batail JM, Coloigner J, Soulas M, Robert G, Barillot C, Drapier D. Structural abnormalities associated with poor outcome of a major depressive episode: The role of thalamus. Psychiatry Res Neuroimaging 2020; 305:111158. [PMID: 32889511 DOI: 10.1016/j.pscychresns.2020.111158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
An identification of precise biomarkers contributing to poor outcome of a major depressive episode (MDE) has the potential to improve therapeutic strategies by reducing time to symptomatic relief. In a cross-sectional volumetric study with a 6 month clinical follow-up, we performed baseline brain grey matter volume analysis between 2 groups based on illness improvement: 27 MDD patients in the "responder" (R) group (Clinical Global Impression- Improvement (CGI-I) score ≤ 2) and 30 in the "non-responder" (NR) group (CGI-I > 2), using a Voxel Based-Morphometry analysis. NR had significantly smaller Grey Matter (GM) volume in the bilateral thalami, in precentral gyrus, middle temporal gyrus, precuneus and middle cingulum compared to R at baseline. Additionally, they exhibited significant greater GM volume increase in the left anterior lobe of cerebellum and posterior cingulate cortex. The latter result was not significant when participants with bipolar disorder were excluded from the analysis. NR group had higher baseline anxiety scores. Our study has pointed out the role of thalamus in prognosis of MDE. These findings highlight the involvement of emotion regulation in the outcome of MDE. The present study provides a step towards the understanding of neurobiological processes of treatment resistant depression.
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Affiliation(s)
- J M Batail
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France.
| | - J Coloigner
- Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France
| | - M Soulas
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France
| | - G Robert
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France
| | - C Barillot
- Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France
| | - D Drapier
- Centre Hospitalier Guillaume Régnier, Academic Psychiatry Department, Rennes F-35703, France; Univ Rennes, INRIA, CNRS, IRISA, INSERM, Empenn U1228 ERL, Rennes F-35042, France; Univ Rennes, "Comportement et noyaux gris centraux" research unit (EA 4712), Rennes F-35000, France
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14
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Moon JH, Han JW, Oh TJ, Choi SH, Lim S, Kim KW, Jang HC. Effect of increased levothyroxine dose on depressive mood in older adults undergoing thyroid hormone replacement therapy. Clin Endocrinol (Oxf) 2020; 93:196-203. [PMID: 32282957 DOI: 10.1111/cen.14189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/22/2020] [Accepted: 04/02/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Depressive mood consequent to hypothyroidism can be reversed with levothyroxine (LT4) replacement therapy. However, it is unclear whether increasing LT4 dose confers additional mood benefits. DESIGN AND PATIENTS A single-blinded before-and-after study of 24 patients with hypothyroidism who were aged 65 years or older and undergoing LT4 replacement therapy with stable doses. MEASUREMENTS Geriatric Depression Scale (GDS-K) and Hyperthyroid Symptom Scale (HSS-K) were assessed at baseline, 3 months after increasing LT4 dose by an additional 12.5 µg/d, and finally 3 months after returning to the baseline dose. RESULTS Serum thyroid-stimulating hormone (TSH) concentrations decreased at the higher LT4 dose (1.95 ± 2.16 vs 0.47 ± 1.09 mIU/L, P < .001) and recovered after returning to the baseline dose. Serum-free thyroxine levels and HSS-K scores were unchanged during the study period. GDS-K scores improved on the increased dose (9.5 ± 6.6 vs 7.5 ± 4.7, P = .029), and this improvement was maintained after returning to the baseline dose (9.5 ± 6.6 vs 7.4 ± 5.4, P = .010). Higher serum TSH was independently associated with both higher GDS-K and depression risk among those with depressive mood (GDS-K > 10) at baseline. CONCLUSIONS Depressive mood improves with increased LT4 dose, without significant hyperthyroid symptoms or signs, in older adults undergoing thyroid hormone replacement. These findings suggest the potential for varying the treatment target for hypothyroidism based on mood status and that low-dose LT4 treatment might be an ancillary treatment for depression.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seongnam-si, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea
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Burke AD, Goldfarb D, Bollam P, Khokher S. Diagnosing and Treating Depression in Patients with Alzheimer's Disease. Neurol Ther 2019; 8:325-350. [PMID: 31435870 PMCID: PMC6858899 DOI: 10.1007/s40120-019-00148-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 11/24/2022] Open
Abstract
Although cognitive and functional impairment are the hallmark features of Alzheimer's disease (AD), neuropsychiatric symptoms associated with AD account for increased rates of disability and profoundly impact the quality of life of both patients and their caregivers. This narrative review of current evidence provides practical guidance in diagnosing and managing depression in patients with AD using pharmacological and nonpharmacological interventions. After apathy, depression is the second most common neuropsychiatric symptom in AD. Diagnosing late-life depression (LLD), particularly in those affected by AD, is complicated because older patients may not meet the criteria for a major depressive disorder. Clinically, late-life depression and dementia can be indistinguishable. Although these two entities are now thought to be related, the pathologic mechanisms remain unclear. Evidence suggests that LLD may be a prodromal symptom of neurodegenerative disease. The various geropsychiatric measures currently used to diagnose, rate the severity of, and monitor the progress of treatment for depression are imperfect. Neuroimaging represents a promising avenue toward understanding the complex pathophysiologic relationships between dementia and LLD, and will support the pursuit of biomarker-driven diagnosis and treatment. Nonpharmacologic interventions to relieve depression in persons with cognitive impairment and dementia include emotion-oriented therapies, behavioral and cognitive-behavioral modification programs, and structured activity programs. Sensory-stimulation therapies and multisensory approaches show some promise for successfully treating depression in patients with dementia, but further rigorous research is needed to establish their validity. Clinical consensus and research appear to support selective serotonin reuptake inhibitors as a first choice for the pharmacological treatment of depression in patients with dementia. However, initial support for these therapies remains variable, and further investigation is needed. Extra care is required in prescribing to this population because of the generally high level of medical and psychiatric comorbidity and the potential difficulty in assessing the cognitively impaired patient's response.
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Affiliation(s)
- Anna D Burke
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
| | | | - Padmaja Bollam
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
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Adopting Graduate Competencies in Opioid Prescribing for Massachusetts Physician Assistant Programs: A Statewide Public Health Response. J Physician Assist Educ 2019; 30:207-213. [PMID: 31664008 DOI: 10.1097/jpa.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Opioid addiction has become a national epidemic. Morbidity and mortality from prescription and synthetic opioid use and abuse have increased at an alarming rate in recent years. Ensuring that physician assistant (PA) graduates have the knowledge to become safe prescribers of medications, including opiates, is a goal of PA training programs. Achieving that goal requires fostering PA student competence regarding current issues in pain control, drug use and misuse, polypharmacy, diversion, self-medication, and substance use disorder. We present a public health approach to addressing that need. Our approach involved developing consensus among the 9 PA programs in Massachusetts concerning the adoption and implementation of statewide, graduate core competencies for the prevention and management of prescription drug misuse. The process implemented in Massachusetts could be used as a model in other states and might be relevant to addressing other public health crises. We present the adopted competencies as well as individual PA programs' curricular approaches.
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17
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Bennabi D, Charpeaud T, Yrondi A, Genty JB, Destouches S, Lancrenon S, Alaïli N, Bellivier F, Bougerol T, Camus V, Dorey JM, Doumy O, Haesebaert F, Holtzmann J, Lançon C, Lefebvre M, Moliere F, Nieto I, Rabu C, Richieri R, Schmitt L, Stephan F, Vaiva G, Walter M, Leboyer M, El-Hage W, Llorca PM, Courtet P, Aouizerate B, Haffen E. Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry 2019; 19:262. [PMID: 31455302 PMCID: PMC6712810 DOI: 10.1186/s12888-019-2237-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. METHOD Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey. RESULTS The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression. CONCLUSION The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
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Affiliation(s)
- D Bennabi
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France.
- Department of Clinical Psychiatry, 25030 Besançon University Hospital, 25030, Besançon, France.
| | - T Charpeaud
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, ToNIC, Toulouse NeuroImaging Center Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J-B Genty
- SYLIA-STAT, 10, boulevard du Maréchal-Joffre, 92340, Bourg-la-Reine, France
| | - S Destouches
- SYLIA-STAT, 10, boulevard du Maréchal-Joffre, 92340, Bourg-la-Reine, France
| | - S Lancrenon
- SYLIA-STAT, 10, boulevard du Maréchal-Joffre, 92340, Bourg-la-Reine, France
| | - N Alaïli
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - F Bellivier
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - T Bougerol
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - V Camus
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, CHRU de Tours, Université de Tours, Inserm U1253 imaging and Brain : iBrain, Tours, France
| | - J-M Dorey
- Old Age Psychiatry Unit, pôle EST, Centre Hospitalier le Vinatier, Bron, France
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
- Geriatrics Unit, CM2R, Hospices civils de Lyon, Hôpital des Charpennes, Villeurbanne, France
| | - O Doumy
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, UMR INRA 1286, NutriNeuro, Université de Bordeaux, Bordeaux, France
| | - F Haesebaert
- Service universitaire des pathologies psychiatriques résistantes, Centre expert FondaMental, PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Centre Hospitalier Le Vinatier, University Lyon 1, Bron, France
| | - J Holtzmann
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - C Lançon
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - M Lefebvre
- Service universitaire des pathologies psychiatriques résistantes, Centre expert FondaMental, PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Centre Hospitalier Le Vinatier, University Lyon 1, Bron, France
| | - F Moliere
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHU Montpellier, University of Montpellier, Montpellier, France
| | - I Nieto
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - C Rabu
- DHU PePSY, Pole de psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - R Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - L Schmitt
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, ToNIC, Toulouse NeuroImaging Center Université de Toulouse, Inserm, UPS, Toulouse, France
| | - F Stephan
- Service hospitalo-universitaire de psychiatrie d'adultes et de psychiatrie de liaison - secteur 1, Centre Expert Dépression Résistante Fondamental, CHRU Brest, hôpital de Bohars, Bohars, France
| | - G Vaiva
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHU de Lille, Hôpital Fontan 1, Lille, France
| | - M Walter
- Service hospitalo-universitaire de psychiatrie d'adultes et de psychiatrie de liaison - secteur 1, Centre Expert Dépression Résistante Fondamental, CHRU Brest, hôpital de Bohars, Bohars, France
| | - M Leboyer
- DHU PePSY, Pole de psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - W El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, CHRU de Tours, Université de Tours, Inserm U1253 imaging and Brain : iBrain, Tours, France
| | - P-M Llorca
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - P Courtet
- Département des Urgences et Post-Urgences Psychiatriques, Centre Expert Dépression Résistante FondaMental, CHU Montpellier, University of Montpellier, Montpellier, France
| | - B Aouizerate
- Old Age Psychiatry Unit, pôle EST, Centre Hospitalier le Vinatier, Bron, France
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
- Geriatrics Unit, CM2R, Hospices civils de Lyon, Hôpital des Charpennes, Villeurbanne, France
| | - E Haffen
- Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
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