Adesão e não-adesão ao tratamento farmacológico para depressão

Hydroalcoholic Extract of Centella asiatica and Madecassic Acid Reverse Depressive-Like Behaviors, Inflammation and Oxidative Stress in Adult Rats Submitted to Stress in Early Life

Major depressive disorder (MDD) is a severe disorder that causes enormous loss of quality of life, and among the factors underlying MDD is stress in maternal deprivation (MD). In addition, classic pharmacotherapy has presented severe adverse effects. Centella asiatica (C. asiatica) demonstrates a potential neuroprotective effect but has not yet been evaluated in MD models. This study aimed to evaluate the effect of C. asiatica extract and the active compound madecassic acid on possible depressive-like behavior, inflammation, and oxidative stress in the hippocampus and serum of young rats submitted to MD in the first days of life. Rats (after the first day of birth) were separated from the mother for 3 h a day for 10 days. When adults, these animals were divided into groups and submitted to treatment for 14 days. After subjecting the animals to protocols of locomotor activity in the open field and behavioral despair in the forced swimming test, researchers then euthanized the animals. The hippocampus and serum were collected and analyzed for the inflammatory cytokines and oxidative markers. The C. asiatica extract and active compound reversed or reduced depressive-like behaviors, inflammation in the hippocampus, and oxidative stress in serum and hippocampus. These results suggest that C. asiatica and madecassic acid have potential antidepressant action, at least partially, through anti-inflammatory and antioxidant profiles.

Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial

Importance

Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety.

Objective

To estimate the efficacy and safety of auricular acupuncture as a treatment for depression.

Design, Setting, and Participants

This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted.

Intervention

Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group's treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group's acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points.

Main Outcomes and Measures

The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score < 5) at 4 weeks, 6 weeks, and 3 months); and adverse events.

Results

A total of 304 participants were screened, and 74 participants (62 women [84%]; median [IQR] age, 29 [23-27] years) were included in the intention-to-treat analysis, with 37 participants randomized to each group (SA and NSA). A total of 47 participants (64%) were followed-up through 3 months. The results showed no statistically significant difference in depressive recovery between the groups at 3 months (14 of 24 participants in the SA group [58%] vs 10 of 23 participants in the NSA group [43%]; risk ratio [RR], 1.34; 95% CI, 0.76-2.45; P = .38). The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at 6 weeks) with no statistically significant differences. However, a statistically significant difference was observed in symptom remission at 3 months (11 of 24 participants in the SA group [46%] vs 3 of 23 participants in the NSA group [13%]; RR, 1.99; 95% CI, 1.16-3.34; P = .02) in favor of SA. There were no significant differences in adverse event rates between the groups, evidencing the intervention's safety. Most participants reported mild pain at the needle application site (33 patients [94%] in the SA group vs 32 patients [91%] in the NSA group). Five participants dropped out of the study due to adverse events.

Conclusions and Relevance

The results of this randomized clinical trial suggest that SA over 6 weeks is safe. Although there was no statistically significant difference between groups for the primary efficacy outcome, patients receiving SA did experience greater symptom remission at 3 months. A larger sample size and longer intervention are needed to further evaluate the efficacy of SA for depression.

Trial Registration

ClinicalTrials.gov Identifier: NCT05855421.

Medicação pactuada como recurso terapêutico no processo de trabalho de um CAPS: contribuições para a enfermagem

Estudo descritivo e exploratório, com abordagem metodológica qualitativa, que teve como objetivo analisar, no processo de trabalho de um Centro de Atenção Psicossocial, a utilização da medicação negociada como recurso terapêutico para a reinserção social e suas contribuições para a enfermagem. Desenvolveu-se em um Centro de Atenção Psicossocial II do município de Alegrete-RS, no período de maio a junho de 2006. Analisaram-se os diários de campo realizados por três pesquisadores, segundo a análise temática de Minayo, sendo que o registro de observação totalizou 390 horas. Dentre os principais resultados destacou-se a negociação da medicação que se apresentou como efetiva no serviço em estudo, e o relacionamento interpessoal entre profissionais e usuário. Conclui-se que é relevante a abordagem da medicação de maneira negociada, pois desta forma o usuário tem autonomia para opinar e decidir sobre as questões referentes ao seu tratamento.

Adesão em saúde e psicoterapia: conceituação e aplicação na enurese noturna

Existem diversos estudos sobre preditores da não adesão, mas poucos mostram estratégias efetivas para lidar com esse problema. Uma revisão da literatura sobre desistência em psicoterapia mostrou que quase metade dos pacientes que ingressam num atendimento não o concluem. A medida na psicoterapia em geral é a de não adesão, ou desistência do tratamento; no presente trabalho serão apresentados dados relativos à adesão ao tratamento da enurese com alarme de urina. A taxa de desistência em um grupo de 61 crianças e adolescentes foi levantada considerando três condições: suas famílias não compareceram aos atendimentos, não responderam ao contato telefônico ou relataram ter abandonado os procedimentos. A desistência correspondeu a 19,6% da amostra e a idade do grupo dos desistentes era significativamente inferior, quando comparada à daqueles que aderiram ao tratamento. A já demonstrada associação entre a intolerância parental e a idade do filho explica os resultados e aponta para a necessidade de trabalho educativo intenso com os pais de adolescentes portadores de enurese.