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Simon GE, Moise N, Mohr DC. Management of Depression in Adults: A Review. JAMA 2024:2819714. [PMID: 38856993 DOI: 10.1001/jama.2024.5756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Importance Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women. Observations Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]). Conclusions and Relevance Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Millen AME, Daniels WMU, Baijnath S. Depression, an unmet health need in Africa: Understanding the promise of ketamine. Heliyon 2024; 10:e28610. [PMID: 38601594 PMCID: PMC11004535 DOI: 10.1016/j.heliyon.2024.e28610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
In Africa, there is currently a paucity of data on the epidemiology of depression, its treatment and management. The prevalence of depression is severely underestimated, with unique circumstances and societal risk factors associated with depression and its public awareness. Treating and managing depression is confounded by an inaccessibility to efficient and low-cost treatments for patients with depression. The aetiology of depression is multifactorial, with various theories implicating multiple neuronal networks. Despite this, the treatment of depression is one-dimensional focussing on outdated theories of depression and mainly targeting dysfunctional neurotransmitter pathways. Hence, it is not surprising that there is a significant increase in the prevalence of patients suffering from treatment resistant depression (TRD), with a large portion of patients deriving little clinical benefit from these traditional anti-depressant therapies. This highlights the need for more effective treatment strategies for depression, especially applicable to resource limited environments such as Africa, where there is little investment in public healthcare resources towards managing mental health disorders. The clinical potential of using ketamine in managing depression has received considerable attention in the past two decades, with the FDA approving esketamine for the management of TRD in 2019. This widespread attention has significantly increased ketamine's appeal as a novel antidepressant. Consequently, many ketamine infusion clinics have been established in Africa. However, there is little regulation or guidance for ketamine infusions. Furthermore, while esketamine is expensive and hence inaccessible to a large portion of the African population, racemic ketamine is significantly cheaper and has demonstrated clinical potential. However, there is currently a limited understanding of the neurological mechanisms of action of racemic ketamine in treating and managing depression, especially in a diverse African population. Therefore, this review aims to provide an African context of depression and the therapeutic potential of ketamine by highlighting aspects of its molecular mechanism of action.
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Affiliation(s)
- Aletta ME. Millen
- Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William MU. Daniels
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sooraj Baijnath
- Integrated Molecular Physiology Research Initiative, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Pence BW, Gaynes BN, Udedi M, Kulisewa K, Zimba CC, Akiba CF, Dussault JM, Akello H, Malava JK, Crampin A, Zhang Y, Preisser JS, DeLong SM, Hosseinipour MC. Two implementation strategies to support the integration of depression screening and treatment into hypertension and diabetes care in Malawi (SHARP): parallel, cluster-randomised, controlled, implementation trial. Lancet Glob Health 2024; 12:e652-e661. [PMID: 38408462 PMCID: PMC10995959 DOI: 10.1016/s2214-109x(23)00592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Although evidence-based treatments for depression in low-resource settings are established, implementation strategies to scale up these treatments remain poorly defined. We aimed to compare two implementation strategies in achieving high-quality integration of depression care into chronic medical care and improving mental health outcomes in patients with hypertension and diabetes. METHODS We conducted a parallel, cluster-randomised, controlled, implementation trial in ten health facilities across Malawi. Facilities were randomised (1:1) by covariate-constrained randomisation to either an internal champion alone (ie, basic strategy group) or an internal champion plus external supervision with audit and feedback (ie, enhanced strategy group). Champions integrated a three-element, evidence-based intervention into clinical care: universal depression screening; peer-delivered psychosocial counselling; and algorithm-guided, non-specialist antidepressant management. External supervision involved structured facility visits by Ministry officials and clinical experts to assess quality of care and provide supportive feedback approximately every 4 months. Eligible participants were adults (aged 18-65 years) seeking hypertension and diabetes care with signs of depression (Patient Health Questionnaire-9 score ≥5). Primary implementation outcomes were depression screening fidelity, treatment initiation fidelity, and follow-up treatment fidelity over the first 3 months of treatment, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03711786, and is complete. FINDINGS Five (50%) facilities were randomised to the basic strategy and five (50%) to the enhanced strategy. Between Oct 1, 2019, and Nov 30, 2021, in the basic group, 587 patients were assessed for eligibility, of whom 301 were enrolled; in the enhanced group, 539 patients were assessed, of whom 288 were enrolled. All clinics integrated the evidence-based intervention and were included in the analyses. Of 60 774 screening-eligible visits, screening fidelity was moderate (58% in the enhanced group vs 53% in the basic group; probability difference 5% [95% CI -38% to 47%]; p=0·84) and treatment initiation fidelity was high (99% vs 98%; 0% [-3% to 3%]; p=0·89) in both groups. However, treatment follow-up fidelity was substantially higher in the enhanced group than in the basic group (82% vs 20%; 62% [36% to 89%]; p=0·0020). Depression remission was higher in the enhanced group than in the basic group (55% vs 36%; 19% [3% to 34%]; p=0·045). Serious adverse events were nine deaths (five in the basic group and four in the enhanced group) and 26 hospitalisations (20 in the basic group and six in the enhanced group); none were treatment-related. INTERPRETATION The enhanced implementation strategy led to an increase in fidelity in providers' follow-up treatment actions and in rates of depression remission, consistent with the literature that follow-up decisions are crucial to improving depression outcomes in integrated care models. These findings suggest that external supervision combined with an internal champion could offer an important advance in integrating depression treatment into general medical care in low-resource settings. FUNDING The National Institute of Mental Health.
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Affiliation(s)
- Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bradley N Gaynes
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Udedi
- Division of Non-Communicable Diseases and Mental Health, Ministry of Health, Lilongwe, Malawi
| | - Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | | - Jullita K Malava
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Ying Zhang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie M DeLong
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Project Malawi, Lilongwe, Malawi
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4
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Liang Y, Zhang X, Li S, Wang Z. Comparison of psychological interventions for anxiety, depression, fatigue and quality of life in colorectal cancer survivors: A systematic review and network meta-analysis protocol. PLoS One 2024; 19:e0298589. [PMID: 38557643 PMCID: PMC10984524 DOI: 10.1371/journal.pone.0298589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Previous studies have found that psychological interventions have a positive effect on improving physical and psychological problems in colorectal cancer survivors. However, there is still a lack of high-quality evidence reviews that summarize and compare the impact of different psychological interventions. The aim of this study was to synthesize existing psychological interventions and use network meta-analysis to explore whether psychological interventions improve anxiety, depression, fatigue and quality of life in colorectal cancer (CRC) survivors. METHODS We will extract relevant randomized controlled trials of psychological interventions for CRC survivors from eight electronic databases, including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsycInFO, CNKI, and Wanfang database. Two reviewers will independently screen the literature and extract data. The risk of bias of the included studies will be assessed using the RoB2: Revised Cochrane Risk of Bias Tool. We will then conduct paired meta-analyses and network meta-analyses of the extracted data, using a frequency-based framework and random effects models. DISCUSSION To the best of our knowledge, this study is the first proposed qualitative and quantitative integration of existing evidence using systematic evaluation and network meta-analysis. This study will inform health policy makers, healthcare providers' clinical intervention choices and guideline revisions, and will help to reduce depression and anxiety in CRC survivors, reduce fatigue, improve quality of life.
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Affiliation(s)
- Yujie Liang
- School of Nursing, Jilin Medical University, Jilin, China
| | - Xu Zhang
- School of Nursing, Peking University, Haidian District, Beijing, China
| | - Shan Li
- Xinjiang Second Medical College, Karamay, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Haidian District, Beijing, China
- Peking University Health Science Centre for Evidence Based Nursing a Joanna Briggs Institute Affiliated Group, Haidian District, Beijing, China
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Qaseem A, Andrews RA, Campos K, Goldzweig CL, MacDonald S, McLean RM, Powell RE, Fitterman N, Basch P, Choi E, Chou R, Hamori CJ, Mount CA, Campos K. Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians. Ann Intern Med 2024; 177:507-513. [PMID: 38437692 DOI: 10.7326/m23-3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness. The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., K.C.)
| | | | - Karen Campos
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., K.C.)
| | | | | | | | - Rhea E Powell
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (R.E.P.)
| | - Nick Fitterman
- Northwell Health, New Hyde Park, New York; Department of Medicine, Huntington Hospital, Huntington, New York; and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (N.F.)
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6
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Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, Tufte JE, Cross JT, Wilt TJ, Crandall CJ, Hicks LA, Balk EM, Cooney TG, Fitterman N, Lin JS, Maroto M, Miller MC, Obley AJ, Owens DK, Shekelle PG, Harrod CS, Yost J. Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert). Ann Intern Med 2024; 177:eL230440. [PMID: 38498880 DOI: 10.7326/l23-0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania
| | - Douglas K Owens
- Stanford Health Policy, Stanford University, Stanford, California
| | | | | | | | - Timothy J Wilt
- Minneapolis VA Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota
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Dobrescu AI, Persad E, Klerings I, Gartlehner G. Update Alert: Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians. Ann Intern Med 2024; 177:eL230441. [PMID: 38498878 DOI: 10.7326/l23-0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Andreea Iulia Dobrescu
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria
| | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria
| | - Irma Klerings
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University of Krems, Krems, Austria, and RTI International, Research Triangle Park, North Carolina
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Legnani F, Tassi L, Surace T, Capuzzi E, Caldiroli A, Clerici M, Buoli M. Is Pilates effective in improving depressive disorders? A comprehensive overview. Int Clin Psychopharmacol 2024:00004850-990000000-00122. [PMID: 38277272 DOI: 10.1097/yic.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Depressive disorders are disabling conditions that account for high social costs. Pilates demonstrated to have several beneficial effects on health. Objective of this manuscript was to systematically review the literature about the effects of Pilates on depressive disorders. A bibliographic search was conducted in the main database sources (Pubmed, Medline, and Scopus). The inclusion criteria consisted of articles written in English language about the effectiveness of Pilates on depressive symptoms. Most of included studies are randomized controlled trials (10 out of 12). The available literature agrees in indicating that Pilates is effective in improving depressive symptoms especially when compared to inactivity and when this practice is administered for a medium-long period (8-16 weeks). In addition, Pilates seems to have at least comparable effectiveness than aerobic exercise. Pilates can be considered a reliable complementary treatment for people with depressive disorders. These findings should be interpreted considering the different types of practice administered as well as the different duration of the programs or rating scales used to assess mood symptoms. Studies with a more homogenous design are needed to confirm and make generalizable the results presented in this review.
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Affiliation(s)
- Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan
| | - Lorenzo Tassi
- School of Medicine and Surgery, University of Milano Bicocca
| | - Teresa Surace
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB)
| | - Enrico Capuzzi
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB)
| | - Alice Caldiroli
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB)
| | - Massimo Clerici
- School of Medicine and Surgery, University of Milano Bicocca
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB)
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Kalayjian A, Laszlo K, Fassler M, Schonrock Z, Delarose KE, Ly AM, English CD, Cirrincione LR. Patterns of psychotropic medication prescribing and potential drug-hormone interactions among transgender and gender-diverse adults within 2 years of hormone therapy. J Am Pharm Assoc (2003) 2024; 64:283-289.e2. [PMID: 37839699 PMCID: PMC10873097 DOI: 10.1016/j.japh.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Transgender and gender-diverse (TGD) people have a high prevalence of psychotropic medication use, yet knowledge about the patient-level psychotropic medication burden is limited. TGD patients may take hormone therapy to meet their gender expression goals. Potential drug-hormone interactions exist between psychotropic medications and hormone therapy, requiring increased knowledge about psychotropic medication use for TGD adults undergoing hormone therapy. OBJECTIVES The objective of this study was to examine the extent of psychotropic medication polypharmacy in a cohort of TGD adults within 2 years of starting hormone therapy. We also characterized potential drug-hormone interactions and the association with psychotropic polypharmacy. METHODS Retrospective cross-sectional analysis of patients with ≥1 transgender health-related visit (2007-2017) in the University of Washington Medical System (Seattle, WA). Eligible patients had ≥1 psychotropic medication including antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics ordered within 2 years of starting hormone therapy (testosterone or estradiol with or without spironolactone, progesterone, finasteride, or dutasteride). We defined psychotropic polypharmacy as ≥2 psychotropic medication orders with overlapping treatment durations for at least 90 days and characterized potential drug-hormone interactions (Lexicomp, Hudson, OH). We descriptively summarized patients with and without polypharmacy (frequencies and percentages) and compared drug-hormone interactions using chi-square or Fishers exact tests (P < 0.05 considered significant). RESULTS A total of 184 patients had ≥1 psychotropic medication order within 2 years of hormone therapy; 68 patients (37.0%) had psychotropic polypharmacy. The most frequent type of psychotropic polypharmacy was antidepressant+sedative-hypnotic (18 of 68, 26.5%). More patients had a potential drug-hormone interaction among those with psychotropic polypharmacy (23 of 68, 33.8%) versus those without (8 of 116, 6.9%, P < 0.001). CONCLUSION Among TGD patients on psychotropic medications within 2 years of hormone therapy, one-third had psychotropic polypharmacy. Most polypharmacy types appeared to align with mental health treatment guidelines. The number of patients with a potential drug-hormone interaction was significantly higher among those with polypharmacy. Prospective studies are needed to characterize drug-hormone interactions.
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Affiliation(s)
- Alin Kalayjian
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Kaeleb Laszlo
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Molly Fassler
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | | | - Andrew M. Ly
- School of Pharmacy, University of Washington, Seattle, WA, USA
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Raspopova NI. [Pathogenetic basis of modern approaches to the therapy of sleep disorders in the clinic of depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:69-74. [PMID: 38676680 DOI: 10.17116/jnevro202412404169] [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] [Indexed: 04/29/2024]
Abstract
Epidemiological studies indicate that about 35% of the world's population periodically suffer from insomnia. Many authors in their studies note sleep disturbances in the clinic of both somatic and mental disorders, often considering sleep disturbances as one of the predictors of these diseases. In psychiatric practice, sleep disorders are most often described in the clinic of depression, which is determined by the general pathophysiological mechanisms of their development due to disruption of the activity of the main neurotransmitter systems of the brain. The results of clinical studies show that the drug of choice in the treatment of sleep disorders in the depression clinic is the antidepressant Mirtazapine, which has a unique profile of pharmacological activity. According to international recommendations, Mirtazapine is a first-line drug in the treatment of anxiety and depressive disorders with sleep disorders and sexual dysfunction caused by taking other antidepressants.
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Affiliation(s)
- N I Raspopova
- Kazakhstan-Russian Medical University, Almaty, Republic of Kazakhstan
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11
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Vittengl JR, Jarrett RB, Ro E, Clark LA. Associations of antidepressant medication consumption with changes in personality pathology and quality of life among community-dwelling adults. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:5-18. [PMID: 37718854 DOI: 10.3233/jrs-230016] [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] [Indexed: 09/19/2023]
Abstract
BACKGROUND Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults. OBJECTIVE We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression. METHOD In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption. RESULTS Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes. CONCLUSION Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.
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Affiliation(s)
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eunyoe Ro
- Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Lee Anna Clark
- Department of Psychology, Notre Dame University, Notre Dame, IN, USA
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12
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Dudek D, Chrobak AA, Krupa AJ, Gorostowicz A, Gerlich A, Juryk A, Siwek M. TED-trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder. Front Pharmacol 2023; 14:1296639. [PMID: 38027034 PMCID: PMC10646491 DOI: 10.3389/fphar.2023.1296639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: Selective serotonin reuptake inhibitors (SSRIs) are the most often used medications to treat major depressive disorder (MDD). Despite their effectiveness in reducing depressive symptoms, several issues are associated with their use in MDD, such as limited improvement of anhedonia, emergence of emotional blunting, induction or exacerbation of insomnia, and sexual dysfunction. Due to its also devoid of the issues related to treatment noted with SSRIs. The aim of this 12-week non-inferiority naturalistic observation was to compare the effectiveness and tolerability of SSRIs and trazodone in extended release (XR) in MDD. Methods: A total of 186 subjects were recruited, of which 92 received trazodone XR and 94 received SSRIs. Patients were allocated to trazodone XR or SSRIs, according to the attending physician based on clinical evaluation. Assessments at baseline and weeks 2, 4, 8, and 12 were conducted to evaluate the severity of depression (Montgomery-Åsberg Depression Rating Scale, clinician- and patient-rated Quick Inventory of Depressive Symptomatology-the primary endpoints of the study), anhedonia (the Snaith-Hamilton Pleasure Scale), anxiety (the Hamilton Anxiety Rating Scale), insomnia (the Athens Insomnia Scale), and therapeutic effectiveness (the Clinical Global Impression Scale). Results: After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of depression, anxiety, and insomnia. There was a trend for higher effectiveness of in reduction of anhedonia, which became insignificant after controlling the results for the duration of previous psychiatric treatment as a covariate. The proportion of treatment-responsive subjects in the trazodone XR group compared to SSRIs was comparable or higher. The proportion of patients achieving remission was higher in the trazodone XR arm vs. the SSRI arm. Discussion: In summary, the results indicate that trazodone XR is effective in MDD in the "real-world" setting. Its potential superiority over SSRIs in addressing particular symptomatic dimensions should be verified in future studies.
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Affiliation(s)
- Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Cracow, Poland
| | | | - Anna Julia Krupa
- Department of Affective Disorders, Jagiellonian University Medical College, Cracow, Poland
| | | | - Adrian Gerlich
- Department of Adult, Child and Adolescent Psychiatry, University Hospital in Cracow, Cracow, Poland
| | - Andrzej Juryk
- Department of Adult Psychiatry, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Cracow, Poland
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Mu J, Ravindran AV, Cuijpers P, Shen Y, Yang W, Li Q, Zhou X, Xie P. Stroke depression: a concept with clinical applicability. Stroke Vasc Neurol 2023:svn-2022-002146. [PMID: 37793901 DOI: 10.1136/svn-2022-002146] [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: 11/15/2022] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Stroke is a common neurological condition and among the leading causes of death and disability worldwide. Depression is both a risk factor for and complication of stroke, and the two conditions may have a complex reciprocal relationship over time. However, the secondary effects of depression on stroke are often overlooked, resulting in increased morbidity and mortality. In the previous concept of 'poststroke depression', stroke and depression were considered as two independent diseases. It often delays the diagnosis and treatment of patients. The concept 'stroke depression' proposed in this article will emphasise more the necessity of aggressive treatment of depression in the overall management of stroke, thus to reduce the incidence of stroke and in the meantime, improve the prognosis of stroke. Hopefully, it will lead us into a new era of acute stroke intervention.
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Affiliation(s)
- Jun Mu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Arun V Ravindran
- Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yiqing Shen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wensong Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Raza S, Thiruchelvam D, Redelmeier DA. Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada. JAMA Netw Open 2023; 6:e2335831. [PMID: 37768661 PMCID: PMC10539992 DOI: 10.1001/jamanetworkopen.2023.35831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care. Objective To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design. Design, Setting, and Participants This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada. Exposure Police shootings compared with other mechanisms of injury involving police. Main Outcomes and Measures Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability. Results Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis. Conclusions and Relevance In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
| | - Donald A. Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Fagiolini A, Cardoner N, Pirildar S, Ittsakul P, Ng B, Duailibi K, El Hindy N. Moving from serotonin to serotonin-norepinephrine enhancement with increasing venlafaxine dose: clinical implications and strategies for a successful outcome in major depressive disorder. Expert Opin Pharmacother 2023; 24:1715-1723. [PMID: 37501324 DOI: 10.1080/14656566.2023.2242264] [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: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Mental health disorders, especially depressive and anxiety disorders, are associated with substantial health-related burden. While the second-generation antidepressants are widely accepted as first-line pharmacological treatment for major depressive disorder (MDD), patient response to such treatment is variable, with more than half failing to achieve complete remission, and residual symptoms are frequently present. AREAS COVERED Here, the pharmacodynamics of venlafaxine XR are reviewed in relation to its role as both a selective serotonin reuptake inhibitor (SSRI) and a serotonin-norepinephrine-reuptake inhibitor (SNRI), and we look at how these pharmacodynamic properties can be harnessed to guide clinical practice, asking the question 'is it possible to develop a symptom-cluster-based approach to the treatment of MDD with comorbid anxiety utilizing venlafaxine XR?.' Additionally, three illustrative clinical cases provide practical examples of the utility of venlafaxine-XR in real-world clinical practice. The place of venlafaxine XR in managing fatigue/low energy, a frequent residual symptom in MDD, is explored using pooled data from clinical trials of venlafaxine XR. EXPERT OPINION Venlafaxine XR should be considered as a first-line treatment for MDD with or without comorbid anxiety, and there are clear pharmacodynamic signals supporting a symptom cluster-based treatment paradigm for venlafaxine XR.
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Affiliation(s)
- Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Narcis Cardoner
- Department of Psychiatry and Legal Medicine, Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - Sebnem Pirildar
- Department of Mental Health and Diseases, Ege University Medical School, Izmir, Turkey
| | - Pichai Ittsakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bernardo Ng
- Mexican Consortium of Neuropsychopharmacology, Mexico, Sun Valley Research Center, Imperial, California, USA
| | - Kalil Duailibi
- Department of Psychiatry, Santo Amaro University, São Paulo, Brazil
| | - Nasser El Hindy
- American Center Neurology and Psychiatry, Dubai, United Arab Emirates
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Correction: Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder. Ann Intern Med 2023; 176:1143-1144. [PMID: 37459618 DOI: 10.7326/l23-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
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Liao H, Rosenthal DS, Kumar SC. Abnormal Thyroid Function Laboratory Results Caused by Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant Treatment. Case Rep Psychiatry 2023; 2023:7170564. [PMID: 37215167 PMCID: PMC10195165 DOI: 10.1155/2023/7170564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Mental health issues, especially depressive disorders, are major burdens to the health care systems. This has been more pronounced since the onset of the COVID-19 pandemic. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for depression. Uncommonly appreciated, however, are the adverse effects these agents may have on thyroid function laboratory test results as well as the clinical thyroidal functional status of such patients, which may lead to erroneous diagnoses and inappropriate treatments. We report on a depressed woman who developed abnormal thyroid biochemical laboratory reports during fluoxetine therapy. After changing to the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine, the thyroid laboratory reports were normalized. In light of this, we wish to alert treating clinicians to this potential significant adverse effect.
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Affiliation(s)
- Huijuan Liao
- Division of Endocrinology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
| | - David S. Rosenthal
- Division of Endocrinology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
| | - Salini C. Kumar
- Division of Endocrinology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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