Transtornos de humor refratários a tratamento

Combined actions of blueberry extract and lithium on neurochemical changes observed in an experimental model of mania: exploiting possible synergistic effects

Bipolar disorder is a psychiatric disease characterized by recurrent episodes of mania and depression. Blueberries contain bioactive compounds with important pharmacological effects such as neuroprotective and antioxidant actions. The aim of this study was to investigate the effects of blueberry extract and/or lithium on oxidative stress, and acetylcholinesterase (AChE) and Na⁺, K⁺-ATPase activity in an experimental ketamine-induced model of mania. Male Wistar rats were pretreated with vehicle, blueberry extract (200 mg/kg), and/or lithium (45 mg/kg or 22.5 mg/kg twice daily) for 14 days. Between the 8th and 14th days, the animals also received an injection of ketamine (25 mg/kg) or vehicle. On the 15th day the animals received a single injection of ketamine; after 30 min, the locomotor activity was evaluated in an open field test. Ketamine administration induced an increase in locomotor activity. In the cerebral cortex, hippocampus and striatum, ketamine also induced an increase in reactive oxygen species, lipid peroxidation and nitrite levels, as well a decrease in antioxidant enzyme activity. Pretreatment with blueberry extract or lithium was able to prevent this change. Ketamine increased the AChE and Na⁺, K⁺-ATPase activity in brain structures, while the blueberry extract partially prevented these alterations. In addition, our results showed that the neuroprotective effect was not potentiated when lithium and blueberry extract treatment were given together. In conclusion, our findings suggest that blueberry extract has a neuroprotective effect against an experimental model of mania. However, more studies should be performed to evaluate its effects as an adjuvant therapy.

Relationship between physical activity and depression and anxiety symptoms: a population study

BACKGROUND

There are few studies evaluating the association between practice of physical activity and mood in a population sample. This study evaluated the frequency of symptoms of depression and anxiety in the population of the city of Sao Paulo and their association with the report of practice of regular physical activity.

METHODS

This survey was conducted with the adult population of Sao Paulo between July and December of 2007. The sample was composed of 1042 volunteers (both genders) with a mean age of 41.9±14.4 years. The volunteers were evaluated using the Beck Depression Inventory, the Beck Anxiety Inventory, and two simple questions designed to evaluate and classify physical activity. Socioeconomic status was also determined according to Brazil's Economic Classification Criterion.

RESULTS

People who do not engage in physical activity are two times more likely to exhibit symptoms of depression (PR: 2.1) and anxiety (PR: 2.5) compared with those who regularly practice physical activity and a higher prevalence of symptoms for anxiety (9.8%) and depression (10.9%) was observed among those claiming to not practice regular physical activity and 63.2% related did not practice any physical activity regularly.

CONCLUSION

Altogether, these results suggest that people who do not practice physical activity have a higher chance of exhibiting symptoms of depression and anxiety when compared to those who perform physical activity regularly. In this sense, regular physical activity must be encouraged, and this incentive should be routine in both current and future public health policies. Although the methodology in the present study does not allow assigning a relation of cause and effect, we observed associations between symptoms of depression, anxiety and physical activity.

[Bipolar affective disorder: pharmacotherapeutic profile and adherence to medication]

This cross-sectional and descriptive study aimed to verify the adherence of patients with Bipolar Affective Disorder (BAD) to medication and to identify possible causes of adherence and non-adherence to medication according to the pharmacotherapeutic profile. The study was carried out in a mental health service in a city in the interior of the state of São Paulo. Participants included 101 patients with BAD. Structured interviews and the Morisky-Green test were used for data collection, and the Statistical Package for Social Science was employed for data analysis. Most subjects (63%) did not adhere to medication. Although there were no significant differences between the adherent and non-adherent groups for the researched variables, the use of polypharmacotherapy and complex treatment regimens was observed in treatment for BAD. In practice, implementing strategies to improve the adherence of patients to medication treatment remains a challenge.

Lipid peroxidation and antioxidant protection in patients during acute depressive episodes and in remission after fluoxetine treatment

Increasing numbers of studies indicate that free radicals and their derivatives play a role in some neuropsychiatric disorders, such as depression. The aim of this study was to investigate the activities of antioxidant enzymes, lipid peroxidation and total antioxidant status (TAS) in patients suffering from major depressive disorder (MDD) as compared to healthy controls. Specifically, we wanted to estimate how fluoxetine influences antioxidant defense and lipid peroxidation. Fifty MDD patients and thirty healthy controls participated in the study. Antioxidant enzyme activities and lipid peroxidation levels were measured in erythrocytes, while TAS was measured in plasma. All measurements were taken during an acute depressive episode and then again during depression remission after a three-month fluoxetine treatment. During acute depressive episodes, patients had significantly higher activity levels of antioxidant enzymes, such as copper-zinc superoxide dismutase (SOD1) and catalase (CAT), as compared to healthy controls. Concentrations of malondialdehyde (MDA) were also significantly higher during depressive episodes. Activity levels of glutathione peroxidase (GPx) did not differ significantly between depressed patients and healthy control subjects. Moreover, the plasma total antioxidant status of the depressed patients was decreased in comparison to control subjects. After three months of fluoxetine treatment, the above parameters did not change significantly. Major depressive disorder is accompanied by disturbances in the balance between pro- and anti-oxidative processes; however, these disturbances do not improve in patients in remission after three months of fluoxetine therapy.