Long-term antidepressant use: patient perspectives of benefits and adverse effects

A qualitative exploration of service users' experiences of weight management conversations in a mental health setting

Objective

Healthcare professionals often use opportunistic weight management conversations, aligned with the Making Every Contact Count (MECC) approach, to provide motivational support to service users. While research supports this practice from the professionals' perspective, the views of service users on these interactions remain understudied. The aim of this study was to explore the experiences of service users with serious mental illness regarding weight management conversations with healthcare professionals.

Methods

Thirteen service users with serious mental illness (Nine inpatient, four community-based) participated in semi-structured 1-1 interviews exploring weight management support experiences. Transcript data was analysed using thematic analysis.

Results

Five key themes were developed: service users' experience of weight management conversations, developing therapeutic relationships, support for physical activity and weight management, deliverer characteristic preferences, and user descriptions of MECC.

Conclusions

Service users reported a lack of information about medication-related weight gain and suggested further staff training to improve therapeutic relationships and weight management support for service users with serious mental illness.

Innovation

This study uniquely explores service users' perspectives on weight management conversations within mental health care, applying MECC in a novel context. It highlights the perspective of individuals with serious mental illness on weight-related issues, challenging existing practices, and proposing strategies for integrating physical health support in mental health settings.

The missing link? Pharmacists' perspectives on discontinuation of long-term antidepressants: a qualitative study

Background

Long-term use of antidepressant drugs is widespread despite guidelines recommending limited duration. General practitioners (GPs) play a central role in reviewing and discontinuing antidepressants, although they hesitate to initiate a discussion about the long-term use. The potential role of pharmacists in this process is underexplored, despite their pharmaceutical expertise and accessibility.

Objectives

To explore community pharmacists' perspectives on the discontinuation of long-term use of antidepressants, and the barriers and facilitators to their involvement in this process.

Design

Qualitative study.

Methods

Semi-structured interviews were conducted with 14 Belgian community pharmacists until data saturation. Interviews were recorded, transcribed, and thematically analyzed.

Results

Four themes emerged. (1) "Antidepressants at the pharmacy: a persistent taboo" showed pharmacists' hesitancy to initiate discontinuation discussions due to societal stigma and fear of being perceived as nosy. (2) "Balancing risks vs benefits" highlights that pharmacists were primarily concerned about relapse in stable patients but recognized that a patient request from a patient experiencing side effects may facilitate discontinuation. (3) "Is this my role?," pharmacists viewed GPs as the primary decision-makers in discontinuation, limiting their role to supporting GP treatment decisions. Key facilitators for discontinuation included a GP's decision to stop and a motivated patient. Regular reviews by the pharmacist could also facilitate the discontinuation process. (4) Optimizing pharmacists' role' with a strong need for GP collaboration, and acknowledging a need to optimize knowledge and skills to support antidepressant discontinuation.

Conclusion

Our study reveals that pharmacists viewed GPs as pivotal in the discontinuation process, as they make the decisions, while they see their role as supportive, following the doctor's decision. However, they faced significant barriers to discontinuing long-term antidepressants, including fear of relapse, societal taboo, and unclear responsibilities. More education, confidence building, and better collaboration with GPs could empower pharmacists to play a proactive role, improving the antidepressant discontinuation process.

Effects of exercise training on cognition in adults with depression: A systematic review and three-level meta-analysis

BACKGROUND

Cognitive impairment is a central feature of depression. Exercise training has enormous potential as a nonpharmacological intervention to improve cognition in depressed individuals.

OBJECTIVE

This review aimed to evaluate and update the effect of exercise training on overall cognition and its subdomains, as well as whether moderators influence the effect of exercise training on cognition in depressed adults.

DESIGN

Systematic review and three-level meta-analysis of randomized controlled trials.

METHODS

We systematically searched Embase, Ovid MEDLINE, Web of Science, PubMed, and Scopus from their inception to February 14, 2024, and updated the search results on December 5, 2024. Randomized controlled trials investigating how exercise training affected cognition in depressed adults were included. The meta-analysis was performed using a random-effects model in R. We used the Physiotherapy Evidence Database scale to evaluate the study's quality.

RESULTS

Twenty-two studies were included. Exercise training showed statistically significant improvements in overall cognition [g = 0.21; 95 % confidence interval (CI) = 0.12, 0.30] and cognitive subdomains of processing speed (g = 0.20; 95 % CI = 0.04, 0.36), attention (g = 0.21; 95 % CI = 0.06, 0.35), memory (g = 0.24; 95 % CI = 0.11, 0.38), and executive function (g = 0.21; 95 % CI = 0.09, 0.33) compared with comparison groups in depressed adults. The greater cognitive benefits were observed when participants exercised twice a week (g = 0.30; 95 % CI = 0.03, 0.56), at a low intensity (g = 0.26; 95 % CI = 0.08, 0.43), spent more than 60 min per session (g = 0.24; 95 % CI = 0.05, 0.44), 150 min or more per week (g = 0.27; 95 % CI = 0.09, 0.45), had a program duration more than 10 weeks (g = 0.25; 95 % CI = 0.12, 0.39), and engaged in mind-body exercise (g = 0.26; 95 % CI = 0.08, 0.43). The clinical setting, sample size, and comparison group for memory moderated the effects of exercise training on cognition.

CONCLUSIONS

Exercise training is an effective nonpharmacological intervention that enhances overall cognition and subdomains of processing speed, attention, memory, and executive function compared with comparison groups in depressed adults. This study only included English-language articles, which may have caused a language bias, and Egger's test revealed a possibility of publication bias.

REGISTRATION NUMBER

CRD42023457900 (PROSPERO).

TWEETABLE ABSTRACT

Exercise training is an effective nonpharmacological intervention for adults with depression to improve overall cognition and cognitive subdomains of processing speed, attention, memory, and executive function compared with comparison groups.

Navacaprant, a Novel and Highly Selective Kappa Opioid Receptor Antagonist, in Adults With Major Depressive Disorder: A Randomized, Double-Blind Phase 2 Clinical Trial

PURPOSE/BACKGROUND

This phase 2a randomized, double-blind, placebo-controlled, 8-week trial assessed the efficacy and safety of navacaprant, a highly selective kappa opioid receptor antagonist, in adults with major depressive disorder (MDD).

METHODS/PROCEDURES

Participants with 17-Item Hamilton Depression Rating Scale (HAMD-17) scores of 14 to 30 were randomized 1:1 to once-daily navacaprant 80 mg or placebo (n = 102 each). The primary endpoint was HAMD-17 change from baseline (CFB) to week 8. Secondary endpoints included CFB in Snaith-Hamilton Pleasure Scale (SHAPS). No adjustment for multiple comparisons was made.

FINDINGS/RESULTS

At week 8, HAMD-17 CFB was not statistically significantly improved with navacaprant vs placebo (least squares mean difference -1.7 [standard error, 1.08], P = 0.121; mixed-models repeated-measures) in the efficacy population. In a prespecified sensitivity analysis using last-observation-carried-forward, navacaprant statistically significantly improved HAMD-17 CFB (-2.9 [0.88], P = 0.002; -2.2 [0.98], P = 0.024) and SHAPS CFB (-2.8 [0.96], P = 0.004; -3.4 [1.10], P = 0.002) vs placebo at weeks 4 and 8. In the prespecified subgroup with moderate-to-severe MDD (baseline HAMD-17 score ≥22; n = 100), navacaprant statistically significantly improved HAMD-17 CFB at both timepoints (-3.0 [1.20], P = 0.015; -2.8 [1.33], P = 0.037) and SHAPS CFB at week 8 (-4.8 [1.35], P = 0.001) vs placebo. Most frequently reported adverse events (AEs) included headache (4.9% both) and nausea (4.9% navacaprant, 1.0% placebo); no serious AEs were reported with navacaprant.

IMPLICATIONS/CONCLUSIONS

Although the primary endpoint was not met in the efficacy population, which included participants with mild depression, statistically significant improvements with navacaprant on depressive symptoms including anhedonia in the moderate-to-severe MDD subgroup, along with a favorable safety profile, support further study of navacaprant for the treatment of MDD.

Transcriptomic Profile of the Male Rat Hypothalamus and Nucleus Accumbens After Paroxetine Treatment and Withdrawal: Possible Causes of Sexual Dysfunction

Paroxetine, a selective serotonin reuptake inhibitor (SSRI), may induce sexual dysfunction during treatment and upon discontinuation. The mechanisms involved have been poorly explored so far. We have analyzed, by RNA sequencing, the whole transcriptomic profile in the hypothalamus and nucleus accumbens (NAc) (two brain regions involved in sexual behavior) of male rats daily treated for 2 weeks with paroxetine (T0) and at 1 month of withdrawal (T1). Data here reported show seven differentially expressed genes (DEGs) at T0 and 1 at T1 in the hypothalamus and 245 at T0 and 6 at T1 in the NAc. In addition, Gene-Set Enrichment, Gene Ontology, and Reactome analyses confirm that inflammatory signature and immune system activation were present at T0 in both brain areas. Considering that inflammation is generally associated with depression and that no paradigms inducing the pathology were here applied, these SSRI pro-depressive effects should be considered in patients without a clear indication of depression. Moreover, DEGs related to neurotransmitters with a role in sexual behavior and the reward system, such as dopamine (e.g., sialyltransferase 8B-ST8SIA3), glutamate (e.g., glutamate receptor ionotropic delta-2-GRID2) and GABA (e.g., glutamate decarboxylase type 2-GAD2) or associated with neurexin and neuroligin pathways and brain-derived neurotrophic factor (BDNF) signaling, were reported to be dysregulated in the NAc, further confirming dysfunction in this brain area. Interestingly, the analysis of DEGs altered at T1 in the NAc confirms the persistence of some of these side effects providing further information for post-SSRI sexual dysfunction (PSSD) etiopathogenesis.

The TAAR1 Agonist PCC0105004 Regulates Amygdala Synaptic Plasticity to Alleviate Anxiety-Like Behaviors in Rats

Anxiety disorder is a persistent, widespread, and intractable mood disorder, and the available pharmacotherapies have limited efficacy with significant side effects. Trace amine-associated receptor 1 (TAAR1) is an emerging drug target for neuropsychiatric disorders. This study examined the effects and underlying mechanisms of a novel TAAR1 agonist, PCC0105004, in a rat model of CUMS-induced anxiety-like behavior. The elevated zero maze and open field tests test were employed to evaluate the anti-anxiety-like activity of PCC0105004. PCC0105004 dose-dependently attenuated anxiety-like behaviors in rats without affecting spontaneous activity. Morphologically, PCC0104005 decreased the density of dendritic spines in the amygdala. For the mechanistic studies, whole-genome transcriptomic analysis revealed significant differences in the patterns of amygdala gene expression in the CUMS-induced anxiety rat model. These transcriptomic data were further confirmed by using RT-qPCR and western blotting, further revealing alterations associated with genes (Col1a1, DCN, Ewsr1) known to regulate synaptic plasticity, and PCC0105004 was able to reverse these changes. These results suggest that PCC0105004 is a promising anxiolytic candidate for pharmacotherapy of anxiety and warrants further examination and development.

Treating obesity in patients with depression: a narrative review and treatment recommendation

The high morbidity of obesity and depression pose significant public health concerns, with the prevalence of obesity doubling in the US between 1990 and 2022 and patients frequently presenting with both. Untreated obesity and depression can greatly impact patient health and well-being, as both obesity and depression are associated with a number of comorbidities including sleep apnea, type 2 diabetes mellitus, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease. This narrative review aims to provide a comprehensive and current overview of the overlapping etiologies between obesity and depression as well as the available treatment options that may be recommended by primary care professionals to treat these patients with concomitant obesity and depression. With the considerable overlap in the population of patients with obesity and depression, as well as the overlap in the neurobiological, hormonal, and inflammatory pathways underlying both diseases, primary care professionals should consider screening patients presenting with obesity for depression. Holistic treatment options, including lifestyle and behavioral modifications, and pharmacotherapy for both depression and obesity and bariatric surgery for obesity are critical to manage both conditions simultaneously. Therefore, due to the overlapping neurobiological pathways and mechanisms responsible for the incidence and progression of both obesity and depression, a holistic treatment plan including strategies with efficacy for both conditions and any additional comorbidities may improve the clinical approach for patients with concomitant obesity and depression.

Examining the Long-Term Impacts of Psychotropic Drugs and Considerations for People Discontinuing Treatment

Psychotropic drugs dominate the mental healthcare landscape. This is despite contention over their proposed mechanism of action, concerns for their adverse effects, and questionable effectiveness, especially over the long term. Mental health nurses are routinely involved in administering psychotropic drugs, observing for and managing adverse effects, and providing information and support to people prescribed these agents. This critique explores the current understanding of the mechanism of action for psychotropic drugs, evidence for their effectiveness, adverse effect burden and implications for long term use. The role of mental health nurses in deprescribing and supporting people to discontinue treatment is considered.

Predicting intentions towards long-term antidepressant use in the management of people with depression in primary care: A longitudinal survey study

BACKGROUND

Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples' beliefs and attitudes towards long-term antidepressant use remain relatively unexplored.

OBJECTIVES

To determine the extent to which beliefs and attitudes towards antidepressant treatment are associated with intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation.

METHODS

A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and explanatory variables were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants' intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months.

RESULTS

277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants' medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. All Theory of Planned Behaviour constructs and concerns were associated with intentions, with more favourable attitudes towards stopping and subjective norms having the strongest associations towards intentions to discontinue antidepressant use.

CONCLUSION

Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.

Protective effects of CoQ10 and L-carnitine against antidepressant-induced mitochondrial dysfunction and teratogenicity in chicken embryos

Fluoxetine (FXT) and alprazolam (APZ), widely used for mental disorders, have poorly studied adverse effects on mitochondrial function, including oxidative phosphorylation, electron transport, and membrane permeability. This study represents the first investigation using a chick embryo model (HH-stage 10, day 1.5) to analyze the teratogenic effects of FXT and APZ and explore the protective potential of coenzyme Q10 (CoQ10) and L-carnitine (CNT). Administration of FXT (10 μM) and APZ (1 μM) resulted in high teratogenic rates of 53 % and 80 %, respectively, predominantly manifesting as lipid myopathy in hatching muscles, characterized by lipid accumulation, myofibril disruption, inflammation, and edema. Gene expression analysis revealed upregulation of acetyl-CoA carboxylase (ACC) and downregulation of carnitine palmitoyltransferase 1 (CPT1), leading to impaired lipid peroxidation and excessive reactive oxygen species (ROS) production. Markers of oxidative stress, including superoxide dismutase (SOD), hydrogen peroxide (H2O2), and nitric oxide (NO), were significantly elevated, correlating with glutathione (GSH) depletion and mitochondrial ultrastructural damage, resulting in reduced ATP production. Notably, co-administration of CoQ10 and CNT with FXT or APZ significantly improved teratogenic and mortality rates and reduced oxidative stress levels. Specifically, CoQ10 (2 μM) in the FXT group significantly reduced SOD, H2O2, and NO levels, while co-treatment with CNT and CoQ10 (2 μM) in the APZ group significantly alleviated NO levels. This pioneering study highlights the novel and crucial potential of CoQ10 and CNT as nutritional supplements to mitigate mitochondrial damage and antioxidant system imbalance caused by FXT and APZ, providing an innovative strategy for clinical application.

[Metabolic adverse drug reactions related to psychotropic drugs]

Metabolic adverse drug reactions (mADR) related to psychotropic drugs have significant health-related effects including weight gain, impaired glucose tolerance, diabetes mellitus and dyslipidemia as well as economic relevance. Nearly all antipsychotics (AP) and many antidepressants (AD) and mood stabilisers may induce weight gain. Weight development in the first weeks or months after the beginning of the therapy is the strongest predictor for weight gain related to AP and AD. The most important risk factors for mADR are antagonistic effects at H1-, 5-HT2C- und M3-receptors and antidopaminergic effects. However, several other systems are also relevant. Systematic monitoring of metabolic parameters is recommended in all patients treated with substances that are associated with an increased risk of mADR. Lifestyle modification, dietary measures, exercise therapy, dose reduction, change and discontinuation of the substance, and additional treatment with metformin and topiramate are evidence-based treatment options for AP-associated weight gain. GLP-1 receptor agonists such as liraglutide are also promising.

Increased odds of metabolic syndrome among adults with depressive symptoms or antidepressant use

Metabolic syndrome (MetS) is a condition that includes a cluster of risk factors for cardiovascular disease. In this paper, we aimed to evaluate the association between depressive symptoms, antidepressant use, duration of antidepressant use, antidepressant type and MetS. Data from the 2005-2018 National Health and Nutrition Examination Surveys were used in this study. Adults were included if they responded to the depressive symptoms and prescription medications questionnaires and had measures of blood pressure, waist circumference, triglycerides, high-density lipoprotein, and fasting plasma glucose. Participants were categorized by their antidepressant use (yes/no), type, and duration. This study included 14,875 participants (50.45% females), with 3616 (23.45%) meeting the criteria for MetS. Participants with higher depressive symptom scores (aOR = 1.04, 95% CI: 1.02, 1.05, p < 0.001) or those with depressive symptoms (aOR = 1.42, 95% CI: 1.17, 1.73, p = 0.001) had higher odds of MetS. A similar associations was seen among those who were on antidepressants compared to those who were not on antidepressants (aOR = 1.24, 95% CI: 1.03, 1.50, p = 0.025). Duration of antidepressant use was not significantly associated with MetS. Participants on tricyclic antidepressants had greater odds of MetS compared to those not taking any antidepressants (aOR = 2.27, 95% CI: 1.31, 3.93, p = 0.004). Our study provides evidence of the association between depressive symptoms, antidepressant use, and MetS, highlighting the importance of monitoring metabolic and cardiovascular alterations in individuals of depression.

Medication adherence, depression levels, and quality of life among young people with depression in Indonesia: a mixed method study

BACKGROUND

Limited information is available on medication adherence, depression levels, and quality of life (QoL) among young individuals with depression in Indonesia.

OBJECTIVES

This study examined factors associated with medication adherence, depression severity, and QoL in young Indonesians with depression. It also explored (1) reasons for good or poor adherence and (2) participants' perceived QoL.

METHODS

A mixed-methods sequential explanatory design was employed from January to June 2022. A national cross-sectional survey of 681 participants was conducted, followed by qualitative interviews with 40 participants.

RESULTS

Low medication adherence was observed in 76.2% of participants. Higher adherence was associated with a bachelor's degree. Lower depression levels were linked to older age, female gender, longer treatment duration, and a family history of psychiatric disorders (p < 0.05). QoL significantly declined among people with higher income, the presence of family psychiatric disorders, lower adherence, and more severe depression level. Qualitative findings highlighted inadequate mental health literacy, marital status, low income, lack of support, and side effects as barriers to adherence. Financial stability and positive social support were critical for better QoL.

CONCLUSION

Key factors influencing medication adherence among young Indonesians with depression included income, national health insurance coverage, mental health literacy, and social support. Strengthening communication between patients and mental health providers, particularly psychiatrist, is essential to optimize treatment plans and improve outcomes.

Aerobic Exercise Training and Depressive Symptoms in People With Multiple Sclerosis: Brief Report on Default-Mode Network Resting-State Functional Connectivity

BACKGROUND

We sought to examine a potential neural mechanism of reduced depressive symptoms in response to aerobic treadmill walking exercise training in people with multiple sclerosis (MS). This includes a secondary analysis of depressive symptom and MRI data from an original randomized controlled trial (RCT) on exercise effects on learning and memory impairment in people with MS.

METHODS

Ten fully ambulatory people with MS were randomly assigned into either a 12-week aerobic treadmill walking condition or active control condition (ie, stretching and range-of-motion activities). All participants completed the Hospital Anxiety and Depression Scale for measurement of depressive symptoms as well as a resting-state functional MRI (fMRI) before and after the 12-week study period.

RESULTS

There were no between-condition differences in depressive symptoms at baseline. Participants who were randomly assigned to the intervention condition demonstrated reductions in depressive symptoms compared with minimal changes for those who underwent the control condition. This corresponded with significant changes in resting-state functional connectivity within the default-mode network (DMN).

CONCLUSIONS

The overall pattern of results suggests that resting-state functional connectivity within the DMN may represent a potential neural mechanism underlying the beneficial effects of exercise on depressive symptoms in people with MS. Such results warrant future consideration in the design and conduct of future RCTs that aim to treat MS-related depression with aerobic exercise training in people with MS who have been prescreened for clinical depression.

Trajectories of antidepressant use and 6-year change in body weight: a prospective population-based cohort study

Background

Antidepressant drug treatment may be associated with weight gain, but long-term studies are lacking.

Methods

We included 3,127 adults (1,701 women) from the REGICOR study, aged 55.6 (SD = 11.6) years on average in 2003-2006, living in the northeast of Spain. They had data at two time points (baseline and a median of 6.3 years later) on self-reported antidepressant use, body weight and height, and on baseline smoking, physical activity, diet quality, education, civil status, and depressive symptoms assessed with the Patient Health Questionnaire (PHQ-9) at follow-up. We defined four trajectories of antidepressant use as follows: never use, new use at follow-up, initial use discontinued, repeated use at both time points. We used multivariable linear models to estimate the association of these trajectories with the percentage of weight change. In people without obesity at baseline (n = 2,404), we also estimated the association with obesity incidence at follow-up.

Results

The average 6-year weight gain was 0.53 kg (1.01% body weight), and 24.5% of the participants gained >5% of body weight. The majority (83.6%) of participants did not report any use of antidepressants, 6.2% initiated during follow-up, 5.1% discontinued it, and 5.1% reported their use at both time points. In multivariable analyses, compared to never users, all trajectories were associated with greater weight gain: +1.78% (0.57, 2.98) for initial use discontinued, +2.08% (0.97, 3.19) for new use at follow-up, and +1.98% (95% CI: 0.75, 3.20) for repeated use. In non-obese participants at baseline (n = 2,404), the odds ratio for becoming obese was 2.06 (1.03, 3.96) for repeated use and non-statistically significant for the other trajectories.

Conclusions

In a population-based adult cohort, repeated use of antidepressants was strongly associated with weight gain. New and discontinued use was associated with weight gain, but non-significantly to obesity incidence. Given the global obesity epidemic and the widespread use of antidepressants, weight management and metabolic monitoring should be encouraged and integrated into depression follow-up guidelines alongside antidepressant prescriptions.

A study on the effects of metacinnabar (β-HgS) on weight and appetite recovery in stressed mice

ETHNOPHARMACOLOGICAL RELEVANCE

Depression is a prevalent stress disorder, yet the underlying physiological mechanisms linking stress to appetite and weight loss remain elusive. While most antidepressants are associated with excessive weight and appetite gain, sertraline (SER) exhibits a lower risk of these side effects. Metacinnabar (β-HgS), the primary component of Tibetan medicine Zuotai, has been shown to enhance mice's resilience against external stress without causing excessive increases in weight or appetite. However, the precise physiological pathway through which β-HgS restores appetite and weight in stressed mice remains unclear.

AIM OF THE STUDY

The objective of this study is to assess the efficacy of β-HgS in ameliorating weight loss and appetite suppression induced by pressure stimulation in mice, as well as elucidate its potential mechanisms of action.

METHODS

The present study employed chronic restraint stress (CRS) and chronic unpredictable mild stress (CUMS) as experimental models to simulate environmental stress encountered in daily life. Subsequently, a series of experiments were conducted, including behavior tests, HE staining of rectal and hippocampal pathological sections, detection of depression-related biological indicators, analysis of intestinal flora diversity, as well as metabolomics analysis of hippocampal and intestinal contents.

RESULT

Dysregulation of glycerophospholipid metabolism may represent the principal pathway underlying reduced appetite, body weight, neurotransmitter and appetite hormone levels, heightened inflammatory response, hippocampal and rectal tissue damage, as well as altered composition of intestinal microbiota in stressed mice. Following intervention with SER and β-HgS in stressed mice, the deleterious effects induced by stress can be ameliorated, in which the medium-dose β-HgS exhibited superior performance.

CONCLUSION

The aforementioned research findings suggest that the stress-induced decrease in appetite and body weight in mice may be associated with dysregulation in glycerophospholipid metabolism connecting the gut-brain axis. β-HgS exhibits potential in ameliorating depressive-like symptoms in mice subjected to stress, while concurrently restoring their body weight and appetite without inducing excessive augmentation. Its therapeutic effect may also be attributed to its ability to modulate glycerophospholipid metabolism status and exert influence on the gut-brain axis.

Targeting histamine in metabolic syndrome: Insights and therapeutic potential

Metabolic syndrome is a complex disorder defined by a cluster of interconnected factors including obesity, insulin resistance, hypertension, hyperlipidemia and hyperglycemia which increase the risk of cardiovascular disease, non-alcoholic fatty liver disease, type 2 diabetes mellitus and other related diseases. Histamine, as a biogenic amine, participates in various physiological processes. Increasing evidence suggests histamine plays critical roles in Metabolic syndrome as well as its associated diseases by interacting with four histamine receptors. In this review, we summarize the functions and mechanisms of histamine in Metabolic syndrome, indicating histamine as a possible target in treating Metabolic syndrome and its associated diseases.

Cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) in chronic and treatment-resistant post-traumatic stress disorder of moderate or higher severity: A health-economic model

OBJECTIVE

To explore the cost-effectiveness of midomafetamine-assisted therapy (MDMA-AT) compared to placebo with therapy (PT) in US healthcare settings.

METHODS

A health state-transition model was used to analyze the cost-effectiveness of MDMA-AT for treating patients with chronic PTSD of moderate or higher severity. Both treatment arms consisted of 3 preparation (90-min), 3 interventional (8-h), and 9 integration (90-min) sessions, lasting ~4 months total. All sessions included psychotherapy, with interventional also including MDMA or placebo. After receiving treatment, patients were distributed across health states of No PTSD (not meeting PTSD diagnostic criteria), Non-Severe PTSD (treatment responders), Severe PTSD (treatment non-responders), and death. Each state had unique healthcare costs and utilities sourced from real-world data analysis and patient data from MDMA-AT clinical trials (including long-term follow-up). The base-case analysis considered the payer's perspective with a 5-year horizon, 3.5% annual cost and effect discounts, and an assumed MDMA medication price of $12,000 per session. Trial-derived utilities and US life tables mortality data were used to calculate quality-adjusted life years (QALY). The main outcome was an incremental cost-effectiveness ratio (ICER) with a $150,000 willingness-to-pay (WTP) threshold.

RESULTS

The base-case ICER was $83,845 per QALY. Total direct costs were $64,745 in the MDMA-AT and $33,132 in the PT arms ($31,613 increment). The costs of intervention were $48,376 for MDMA-AT and $12,376 for PT. The highest MDMA medication cost to fit under the WTP threshold was $20,314 per session. Costs related to PTSD healthcare visits and other PTSD treatments were lower with MDMA-AT than PT (-$2,511 and -$1,877 increments, respectively). Utility benefits were higher in MDMA-AT than PT, with 3.691 and 3.314 QALYs generated over 5 years, respectively (0.377 QALY increment).

CONCLUSION

These data suggest MDMA-AT may be a cost-effective treatment compared to PT for patients with chronic PTSD of moderate or higher severity.

Assessment of mood after severe acquired brain injury: Interviews with UK clinical psychologists and medical professionals

OBJECTIVE

Mood assessment is challenging when people have cognitive and receptive communication impairments after severe brain injury. This study explored how UK-based medical and psychology professionals working with people with severe cognitive and communication impairments after brain injury assess mood in this population.

DESIGN

Following their participation in an online survey, professionals were invited to participate in individual semi-structured interviews. Interviews were analysed using thematic analysis to label explicit data (semantic themes) and implicit data (latent themes).

PARTICIPANTS

Twenty-three clinical psychologists and nine medical professionals participated in online or in-person interviews.

RESULTS

Both groups explicitly reported using a combination of collateral information, history, observations, and patient interviews when assessing mood in this population. Medical professionals did not routinely use standardised measures and clinical psychologists often adjusted them when they used them. The respondents discussed difficulties conceptualising depression after brain injury, the experience needed by the assessor, and the need for an individualised approach for this population. Clinical psychologists discussed the pressures of working in healthcare systems and medical professionals discussed how symptoms may influence prescription choices. Seven latent themes were labelled which highlighted additional challenges and complexities experienced by those assessing mood, beyond the actual assessment process itself.

CONCLUSIONS

No 'gold standard' approach to assessing mood in those with cognitive and communication difficulties after severe brain injury was identified. There was overlap in assessment approaches but no clear consensus. Interviewees felt that mood assessment must be approached differently in this population and that self-report measures are not useful.

Efficacy of vortioxetine versus desvenlafaxine in the treatment of functional impairment in patients with major depressive disorder: Results from the multinational VIVRE study

BACKGROUND

In VIVRE (NCT04448431), vortioxetine was associated with significantly higher rates of symptomatic and functional remission, better daily and social functioning, and greater treatment satisfaction than desvenlafaxine in patients with major depressive disorder (MDD) and partial response to selective serotonin reuptake inhibitor (SSRI) therapy. This analysis further explored the relative improvement in patient functioning with vortioxetine versus desvenlafaxine.

METHODS

VIVRE was a randomized, double-blind study of vortioxetine (10 or 20 mg/day) versus desvenlafaxine (50 mg/day) in adults with MDD and partial response to initial SSRI monotherapy. Mean percentage changes from baseline to week 8 in Functioning Assessment Short Test (FAST) total and domain scores were analyzed by treatment group in the overall population and in working patients.

RESULTS

In the overall population, the mean reduction in FAST total score from baseline after 8 weeks of treatment was 37.2% in vortioxetine-treated patients versus 31.8% in desvenlafaxine-treated patients (P = 0.04). Significantly greater improvements versus desvenlafaxine were seen in vortioxetine-treated patients for FAST autonomy, cognitive functioning, and interpersonal-relationships scores (all P < 0.05). In working patients, the mean reduction in FAST total score from baseline at week 8 was 38.7% versus 32.1% in the vortioxetine and desvenlafaxine groups, respectively (P = 0.04). Significant correlations were seen between absolute changes in patient functioning, and those in depression severity and health-related quality of life.

CONCLUSION

Vortioxetine was significantly better than desvenlafaxine in improving overall functioning as well as daily, social, and cognitive functioning in patients with MDD with inadequate response to prior SSRI therapy.

Methylcobalamin as a candidate for chronic peripheral neuropathic pain therapy: review of molecular pharmacology actiona

Chronic peripheral neuropathic pain therapy currently focuses on modulating neuroinflammatory conditions. Methylcobalamin (MeCbl), a neuroregenerative agent, modulates neuroinflammation. This review aimed to explore the molecular pharmacology action of MeCbl as a chronic peripheral neuropathic pain therapeutic agent. MeCbl plays a role in various cellular processes and may have therapeutic potential in neurodegenerative diseases. Intracellular MeCbl modulates inflammation by regulating the activity of T lymphocytes and natural killer cells as well as secretion of inflammatory cytokines, namely, tumor necrosis factor-α, interleukin-6, interleukin-1β, epidermal growth factor, and neuronal growth factor. MeCbl can reduce pain symptoms in chronic neuropathic pain conditions by decreasing excitation and hyperpolarization-induced ion channel activity in medium-sized dorsal root ganglion (DRG) neurons and the expression of transient receptor potential ankyrin 1, transient receptor potential cation channel subfamily M member 8, phosphorylated p38MAPK, transient receptor potential cation channel subfamily V members 1 and 4 in the DRG, and the voltage-gated sodium channel in axons.

LSDDEP2: study protocol for a randomised, double-dummy, triple-blind, active placebo-controlled, parallel groups trial of LSD microdosing in patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) poses a significant global health burden with available treatments limited by inconsistent efficacy and notable side effects. Classic psychedelics, including lysergic acid diethylamide (LSD), have garnered attention for their potential in treating psychiatric disorders. Microdosing, the repeated consumption of sub-hallucinogenic doses of psychedelics, has emerged as a self-treatment approach for depression within lay communities. Building upon preliminary evidence and the successful completion of an open-label pilot trial of microdosing LSD for depression (LSDDEP1), this protocol outlines a phase 2b randomised controlled trial (LSDDEP2). The main objective of LSDDEP2 is to assess the modification of depressive symptoms, measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), following a regimen of LSD microdoses versus placebo.

METHODS

This is a randomised, double-dummy, triple-blind, active placebo-controlled, parallel groups trial of LSD microdosing in patients meeting DSM-5 criteria for major depressive disorder. Participants will undergo an 8-week LSD microdosing regimen using the titratable MB-22001 formulation taking two doses a week. All doses will be self-administered at home and will be titratable from 4 to 20 μg based on subjective perception and tolerability. In addition to depression symptoms, outcome will include psychiatric and personality inventories, sleep and activity tracking, electroencephalography (EEG), blood biomarkers, semi-structured interviews, and safety (e.g. adverse event, laboratory exam) measures.

DISCUSSION

This study will be the first randomised controlled trial to administer controlled microdoses of LSD for treatment of MDD in participants' naturalistic environment. The measures included are designed to assess the drug's safety, mechanism, and treatment efficacy over placebo in this population. The results of this study will be important for assessing the viability of psychedelic microdosing as an additional treatment option and for informing the direction of future clinical trials.

TRIAL REGISTRATION

ANZCTR, ACTRN12624000128594. Prospectively Registered on 13 February 2024.

Progress of research on the treatment of depression by traditional Chinese medicine prescriptions

Depression is a common psychiatric disorder that belongs to the category of "Depression Syndrome" in traditional Chinese medicine (TCM), and its etiology and pathogenesis are complex and unclear. It is characterized by high prevalence, high disability rate, and high recurrence rate, which seriously affect human health, and its treatment has become a research hotspot worldwide. At present, the antidepressants commonly used in the clinic are mainly Western medicine (WM), but there are problems such as frequent side effects and poor efficacy. Studies have found that the use of TCM prescriptions in the treatment of depression can achieve the same effect as WM; and when TCM prescriptions are combined with WM, the efficacy can be enhanced while the adverse effects of WM can be reduced. Pharmacological studies related to the treatment of depression with traditional Chinese medicine prescriptions (TCMPs) have focused on the neurobiochemical system, gut microbes, and energy metabolism in mitochondria. No one has yet reviewed the pharmacological mechanism of TCMPs for depression. So, this paper reviews the pharmacological mechanism of TCMPs for depression from the perspective of TCMPs, introduces the progress of research on classical TCMPs for depression and their antidepressant mechanism. This article aims to promote the application of TCMPs in the clinic and provide a new therapeutic idea for the clinical treatment of depression.

Effectiveness of Vortioxetine for the Treatment of Emotional Blunting in Patients with Major Depressive Disorder Experiencing Inadequate Response to SSRI/SNRI Monotherapy in Spain: Results from the COMPLETE Study

Background

The multinational, open-label COMPLETE study (NCT03835715) investigated the effectiveness of vortioxetine in alleviating emotional blunting in patients with major depressive disorder (MDD) experiencing inadequate response and emotional blunting while being treated with a selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI). This paper presents results for the subgroup of patients enrolled in Spain.

Methods

Patients with MDD (n = 67) experiencing partial response and emotional blunting during monotherapy with an SSRI or SNRI were switched to vortioxetine (10-20 mg/day) for 8 weeks. The primary study outcome was emotional blunting, assessed by the Oxford Depression Questionnaire (ODQ).

Results

After 8 weeks of vortioxetine, the mean (SE) change in ODQ total score from baseline was -26.0 (2.9) (P < 0.001). Respective changes in Montgomery-Åsberg Depression Rating Scale (MADRS), Motivation and Energy Inventory, Digit Symbol Substitution Test, and Sheehan Disability Scale (SDS) total scores were -14.9 (0.8), +34.2 (4.5), +6.3 (1.6), and ‒9.0 (1.3) (all P < 0.001 vs baseline). At week 8, 70.4% of patients no longer reported emotional blunting and 53.7% had achieved remission from their depressive symptoms (defined as a MADRS total score ≤10). Mediation analysis showed 77.1% of the change in SDS total score to be a direct effect of the improvement in ODQ total score after switching to vortioxetine. Adverse events were reported by 35 patients (52.2%), most commonly nausea (14 patients, 20.9%). At week 8, 33/54 patients (61.1%) were receiving vortioxetine 20 mg/day.

Conclusion

In this study investigating the effectiveness of vortioxetine in Spanish patients with MDD who experienced inadequate response and emotional blunting on SSRI/SNRI monotherapy, significant improvements in emotional blunting, core depressive symptoms (including anhedonia), sleep duration, motivation and energy, cognitive performance, and overall patient functioning were observed during the 8 weeks of treatment. Two-thirds of patients no longer reported emotional blunting and over half were in remission from their depressive symptoms at week 8.

What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients' experiences and expectations

BACKGROUND

Many patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use of antidepressants is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging.

AIM

To understand patients' expectations about discontinuation, to document their experiences with long-term use and discontinuation, and to identify factors that can help or hinder discontinuation.

DESIGN AND SETTING

Qualitative study using semi-structured interviews via telephone with adult patients in Germany.

METHOD

We interviewed 32 patients with remitted major depressive disorder and long-term antidepressant use. We analysed transcripts with content analysis aided by MAXQDA to derive thematic categories.

RESULTS

Patients expected to eliminate side effects or regain independence after discontinuation. Such positive expectations were perceived as facilitators and motivated patients' wish to discontinue antidepressants. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients' negative expectations were often fuelled by previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as being effective, but experienced side effects and further problems. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information.

CONCLUSION

Patients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. Promoting functional expectations and specifying individualised approaches to minimise dysfunctional expectations, adapted to patients' previous experiences, appear to be especially important.

Feasibility and preliminary efficacy of a theory-informed resistance exercise training single-arm intervention for major depression

Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes.

PURPOSE

To assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow.

METHODS

Ten adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility.

RESULTS

Nine participants completed the intervention. Strong feasibility and acceptability (98 % adherence, 93 % compliance, and 90 % retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges' g = 0.84-2.13). There were small-to-moderate increases in MCA velocity (g = 0.32-0.57) and conductance (g = 0.20-0.76) across time, with minimal changes in pulsatility (all g < 0.21).

CONCLUSIONS

Preliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET's efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.

Mental health after lumbar spine surgery: cognitive appraisal processes and outcome in a longitudinal cohort study

BACKGROUND CONTEXT

A not uncommon finding following spine surgery is that many patients do not achieve mental health improvement up to population norms for their age cohort, despite improvement in pain and functioning.

PURPOSE

This study examined how patients who were categorized as depressed versus not depressed think about health-related quality of life as assessed by cognitive-appraisal processes. It examined cross-sectional and longitudinal differences over 12 months postsurgery.

DESIGN

Prospective longitudinal cohort study with data collected at presurgery and at ∼3- and ∼12-months postsurgery from August 2013 to August 2023.

PATIENT SAMPLE

We included 173 adults undergoing lumbar spine surgery for degenerative spinal conditions at an academic medical center. The study sample was 47% female, with a mean age of 61 (SD=15.0), and a median level of education of college graduate.

OUTCOME MEASURES

Depression was defined as a Mental Component Score (MCS)≤38 on the Rand-36, building on studies that equated MCS scores with significant depression as assessed by clinically validated depression scales. The Quality-of-Life Appraisal Profile assessed the cognitive-appraisal domains of Experience Sampling and Standards of Comparison.

METHODS

The analysis focused on two comparisons: cross-sectionally comparing those who were not depressed (n=82) to those who were depressed (n=77) at baseline; and comparing longitudinal trajectories among those depressed before surgery and improved (n=54) versus did not improve (n=23). T-tests characterized group differences in appraisal endorsement; analysis of variance evaluated appraisal items in terms of explained variance; and Pearson correlation coefficients assessed direction of association in predicting mental health.

RESULTS

There were presurgical and longitudinal differences in both cognitive appraisal domains. Before surgery, depressed patients were less likely than nondepressed patients to endorse emphasizing the positive; more likely to focus on worst moments, recent flare-ups, their spinal condition, and the future; and more likely to compare themselves to high aspirations (eg, perfect health). Over time, among those who were depressed before surgery, those who improved focused decreasingly on worst moments and on the time before their spinal condition, and increasingly on emphasizing the positive and balancing the positives/negatives. Appraisal explained more variance in mental health among those who did not improve as compared to those who did, at all timepoints. All appraisal items were more highly correlated with mental health among those who remained depressed as compared to those who improved, particularly over time.

CONCLUSIONS

Endorsement of cognitive appraisal processes was different for depressed versus nondepressed spine-surgery patients before surgery and distinguished those who were depressed before surgery and improved versus those who did not improve. These findings suggest that targeted interventions could be beneficial for addressing mental health concerns during the spine surgery recovery trajectory. These interventions might use appraisal measures to identify patients likely to remain depressed after surgery, and then focus on helping these patients shift their focus and standards of comparison.

Social media group support for antidepressant deprescribing: a mixed-methods survey of patient experiences

Background Antidepressant use has continually increased in recent decades and although they are an effective treatment for moderate-to-severe depression, when there is no longer a clinical benefit, deprescribing should occur. Currently, routine deprescribing is not part of clinical practice and research shows that there has been an increase in antidepressant users seeking informal support online. This small scoping exercise used a mixed-methods online survey to investigate the motives antidepressant users have for joining social media deprescribing support groups, and what elements of the groups are most valuable to them. Methods Thirty members of two antidepressant deprescribing Facebook groups completed an online survey with quantitative and open-text response questions to determine participant characteristics and motivation for group membership. Quantitative data were analysed using descriptive statistics, and open-text responses were analysed thematically through NVivo. Results Two overarching themes were evident: first, clinician expertise , where participants repeatedly reported a perceived lack of skills around deprescribing by their clinician, not being included in shared decision-making about their treatment, and symptoms of withdrawal during deprescribing going unaddressed. Motivated by the lack of clinical support, peer support developed as the second theme. Here, people sought help online where they received education, knowledge sharing and lived experience guidance for tapering. The Facebook groups also provided validation and peer support, which motivated people to continue engaging with the group. Conclusions Antidepressant users who wish to cease their medication are increasingly subscribing to specialised online support groups due to the lack of information and support from clinicians. This study highlights the ongoing need for such support groups. Improved clinician understanding about the complexities of antidepressant deprescribing is needed to enable them to effectively engage in shared decision-making with their patients.

Impact of antidepressant use on post-operative weight loss following bariatric surgery

BACKGROUND

Antidepressant medication can be associated with weight gain. Consideration should be given to the specific agent prescribed to optimize bariatric surgery outcomes.

AIM

The aim of this study is to investigate if patients treated with antidepressants stratified by risk of weight gain are associated with less weight loss at 1 year postbariatric surgery.

METHOD

A single centre, retrospective analysis of all patients who underwent bariatric surgery between July 2018 and 2021 within St Vincent's University Hospital group. The exposure was antidepressant use, stratified for risk of weight gain, and the control group was patients who underwent surgery but no antidepressant use. The primary outcome was % TWL (total weight loss) at 6 weeks, 6 months and 12 months post-surgery. Multivariate linear regression analysis was used to estimate the impact of antidepressant treatment on post-surgery weight loss at 12 months using the variables of age, gender and pre-operative BMI.

RESULTS

Of the total cohort (n = 315), 70 patients (22.2%) were taking antidepressants. At 12 months, post-operatively patients taking medium risk for weight gain antidepressants had significantly less mean %TWL compared to those not taking antidepressants (p = 0.015). Overall, taking any antidepressant was not found to be a significant predictor of %TWL at 12 months after surgery (β =  - 2.590, p = 0.0836).

CONCLUSION

Many patients undergoing bariatric surgery have concurrent psychiatric conditions. Given the complex relationship between bariatric surgery and mental health, psychotropic medications may be best managed by a specialist in the field such as a bariatric psychiatrist in order to optimize patient outcomes.

Understanding Australian general practice patients' decisions to deprescribe antidepressants in the WiserAD trial: a realist informed approach

OBJECTIVES

To evaluate how an approach to antidepressant deprescribing works, for whom, and in what contexts by (1) examining the experiences and perceptions of the approach for antidepressant users, (2) identifying the mechanisms of the approach and (3) describing what contexts are associated with antidepressant tapering.

DESIGN

This mixed methods study was informed by the principles of realist evaluation and was conducted in the first 3 months of participation in the WiserAD randomised control trial.

SETTING

General practice, Victoria, Australia.

PARTICIPANTS

13 antidepressant users from general practice participating in the WiserAD trial for antidepressant deprescribing.

INTERVENTION

A patient-facing, web-based structured support tool that consists of a personalised tapering schedule, an action plan for managing withdrawal symptoms, a daily mood, sleep and activity tracker and mental health nurse support.

PRIMARY/SECONDARY OUTCOME MEASURES

The outcomes of the study were revealed on data analysis as per a realist evaluation approach which tests and refines an initial programme theory.

RESULTS

The contexts of learnt coping skills, knowledge and perceptions of antidepressants and feeling well were evident. Outcomes were intention to commence, initiation of deprescribing and successful completion of deprescribing. Key mechanisms for antidepressant deprescribing were (1) initiation of the deprescribing discussion; (2) patient self-efficacy; (3) provision of structured guidance; (4) coaching; (5) mood, sleep and activity tracking and (6) feelings of safety during the tapering period.

CONCLUSIONS

The WiserAD approach to antidepressant deprescribing supported participants to commence and/or complete tapering. The refined programme theory presents the WiserAD pragmatic framework for the application of antidepressant deprescribing in clinical practice.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT05355025; ACTRN12622000567729; ISRCTN11562922; Pre-results.

What a pain in the … back: a review of current treatment options with a focus on naproxen sodium

Non-specific low back pain (LBP) represents a challenging and prevalent condition that is one of the most common symptoms leading to primary care physician visits. While established guidelines recommend prioritizing non-pharmacological approaches as the primary course of action, pharmacological treatments are advised when non-pharmacological approaches are ineffective or based on patient preference. These guidelines recommend non-steroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxers (SMRs) as the first-line pharmacological options for acute or subacute LBP, while NSAIDs are the exclusive first-line pharmacological option for chronic LBP. Although SMRs are generally effective for acute LBP, the available evidence does not support the view that they improve functional recovery, and their comparative efficacy to NSAIDs and other analgesics remains unknown, while studies have shown them to introduce adverse events without significantly reducing LBP. Moreover, opioids continue to be widely prescribed for LBP, despite limited evidence for effectiveness and known risks of addiction and overdose. Broader use of non-opioid pharmacotherapy, including the appropriate use of OTC options, is critical to addressing the opioid crisis. The balance of evidence indicates that NSAIDs have a favorable benefit-risk profile when compared to other available pharmacological treatment options for non-specific LBP, a condition that is primarily acute in nature and well-suited for self-treatment with OTC analgesics. While clinical guidelines do not differentiate between NSAIDs, evidence indicates that OTC naproxen sodium effectively relieves pain across multiple types of pain models, and furthermore, the 14-h half-life of naproxen sodium allows sustained, all day pain relief with reduced patient pill burden as compared to shorter acting options. Choosing the most appropriate approach for managing LBP, including non-pharmacological options, should be based on the patient's condition, severity of pain, potential risks, and individual patient preference and needs.

Eliciting Depression Patients' Preferences for Medication Management: A Protocol for Discrete Choice Experiment

Introduction

Depression threatens people's lives and imposes huge economic burden. Antidepressant therapy is the first-line treatment for depression, and patient adherence to medication is the key to successful treatment. Depression patients have poor medication adherence, which leads to failure of depression management and significantly poorer clinical outcomes. Incorporating patient preferences into clinical decisions can improve uptake rates, optimize treatment adherence. A discrete choice experiment (DCE) can elicit and quantify individual preferences. Previous DCE studies were conducted in developed countries and ignored the influences of factors other than the medication. This paper outlines an ongoing DCE that aims to (1) explore medication-management-related characteristics that may affect depression patients' adherence to antidepressant, (2) elicit how depression patients consider the trade-offs among different medication managements.

Methods

The six attributes and their levels were developed through a literature review, semi-structured interviews and experts and focus group discussions. A fractional factorial design in the software Ngene 1.2 version was used to generate 36 choice sets, and they were divided into 3 blocks. A mixed logit model will be used to explore the patients' preferences, willingness to pay and uptake rate of depression patients for medication management attributes.

Results

The final questionnaire consists of three parts. The first is the introduction, which introduces the purpose of the study and the requirements of completing the questionnaire. This was followed by a general information questionnaire, which included sociodemographic characteristics. The last part is DCE tasks, which include 13 DCE choice sets, and each choice set include two alternative and one "opt-out" option. The pilot-test results showed the questionnaire was easy to understand and could be used in formal surveys.

Conclusion

Our study shows how the development process of the study can be conducted and reported systematically and rigorously according to the theoretical foundation and design principles in DCE.

The lived experience of withdrawal from Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants: A qualitative interview study

BACKGROUND

Our knowledge of the broader impacts of antidepressant withdrawal, beyond physical side effects, is limited. Further research is needed to investigate the lived experiences of withdrawal, to aid clinicians on how to guide patients through the process.

AIM

To explore antidepressant users' experiences and views on the withdrawal process and how it affected their quality of life across multiple life domains.

DESIGN AND SETTING

We conducted in-depth qualitative interviews with 20 individuals from the community who had attempted to withdraw from Serotonin Reuptake Inhibitor antidepressants in the past year.

METHOD

Semi-structured interviews were conducted online. A topic guide was used to ensure consistency across interviews. The interviews were audio-recorded and transcribed verbatim and analysed using inductive reflexive thematic analysis.

RESULTS

Five themes were generated. The first highlighted the challenges of managing the release from emotional blunting and cognitive suppression following antidepressant discontinuation. The second related to the negative impact of withdrawal on close relationships and social interactions. The third showed that concurrent with negative physical symptoms, there was a positive impact on health (exercise was reported by some as a coping mechanism). The fourth theme focused on support from GPs and families, emphasising the importance of mental health literacy in others. The final theme underscored the importance of gradual and flexible tapering in enabling a manageable withdrawal experience, and the consideration of timing.

CONCLUSION

The lived experience of withdrawal significantly impacts individuals' well-being. Participants emphasised that withdrawal is not just about physical side effects but also affects their emotional, cognitive, and social functioning.

PATIENT AND PUBLIC INVOLVEMENT (PPI)

Eight people attended individual online meetings to share their experiences of antidepressant withdrawal to help inform the study design and recruitment strategy. Insights from these meetings informed the development of the topic guide. Questions about GP involvement, family relationships, and mood and thinking changes were included based on this PPI work. This ensured the inclusion of topics important to antidepressant users and facilitated the researcher's questioning during the interviews.

A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication

Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.

Psychotropic Drug-Related Weight Gain and Its Treatment

Psychotropic drug-related weight gain (PDWG) is a common occurrence and is highly associated with non-initiation, discontinuation, and dissatisfaction with psychiatric drugs. Moreover, PDWG intersects with the elevated risk for obesity and associated morbidity that has been amply reported in the psychiatric population. Evidence indicates that differential liability for PDWG exists for antipsychotics, antidepressants, and anticonvulsants. During the past two decades, agents within these classes have become available with significantly lower or no liability for PDWG and as such should be prioritized. Although lithium is associated with weight gain, the overall extent of weight gain is significantly lower than previously estimated. The benefit of lifestyle and behavioral modification for obesity and/or PDWG in psychiatric populations is established, with effectiveness similar to that in the general population. Metformin is the most studied pharmacological treatment in the prevention and treatment of PDWG, and promising data are emerging for glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, semaglutide). Most pharmacologic antidotes for PDWG are supported with low-confidence data (e.g., topiramate, histamine-2 receptor antagonists). Future vistas for pharmacologic treatment for PDWG include large, adequately controlled studies with GLP-1 receptor agonists and possibly GLP-1/glucose-dependent insulinotropic polypeptide co-agonists (e.g., tirzepatide) as well as specific dietary modifications.

Accelerated transcranial magnetic stimulation for major depressive disorder: A quick path to relief?

Transcranial magnetic stimulation (TMS) is a safe, tolerable, and evidence-based intervention for major depressive disorder (MDD). However, even after decades of research, nearly half of the patients with MDD fail to respond to conventional TMS, with responding slowly and requiring daily attendance at the treatment site for 4-6 weeks. To intensify antidepressant efficacy and shorten treatment duration, accelerated TMS protocols, which involve multiple sessions per day over a few days, have been proposed and evaluated for safety and viability. We reviewed and summarized the current knowledge in accelerated TMS, including stimulation parameters, antidepressant efficacy, anti-suicidal efficacy, safety, and adverse effects. Limitations and suggestions for future directions are also addressed, along with a brief discussion on the application of accelerated TMS during the COVID-19 pandemic. This article is categorized under: Neuroscience > Clinical Neuroscience.

Mechanisms of SSRI Therapy and Discontinuation

SSRIs are one of the most widely used drug therapies in primary care and psychiatry, and central to the management of the most common mental health problems in today's society. Despite this, SSRIs suffer from a slow onset of therapeutic effect and relatively poor efficacy as well as adverse effects, with recent concerns being focused on a disabling SSRI discontinuation syndrome. The mechanism underpinning their therapeutic effect has long shifted away from thinking that SSRIs act simply by increasing 5-HT in the synapse. Rather, a current popular view is that increased 5-HT is just the beginning of a series of complex downstream signalling events, which trigger changes in neural plasticity at the functional and structural level. These changes in plasticity are then thought to interact with neuropsychological processes to enhance re-learning of emotional experiences that ultimately brings about changes in mood. This compelling view of SSRI action is underpinning attempts to understand fast-acting antidepressants, such as ketamine and psychedelic drugs, and aid the development of future therapies. An important gap in the theory is evidence that changes in plasticity are causally linked to relevant behavioural effects. Also, predictions that the SSRI-induced neural plasticity might have applicability in other areas of medicine have not yet been borne out. In contrast to the sophisticated view of the antidepressant action of SSRIs, the mechanism underpinning SSRI discontinuation is little explored. Nevertheless, evidence of rebound increases in 5-HT neuron excitability immediately on cessation of SSRI treatment provide a starting point for future investigation. Indeed, this evidence allows formulation of a mechanistic explanation of SSRI discontinuation which draws on parallels with the withdrawal states of other psychotropic drugs.

Exercise for the Prevention and Treatment of Depression

Depression is among the world's leading causes of disability and accounts for a significant loss of life. Despite large investments in research for antidepressants and psychotherapies, non-response, partial response, and small effects remain significant problems. Exercise and physical activity are two lifestyle behaviors that have been studied for well over half a century for the prevention and treatment of depression. The aim of this chapter is to summarize the current evidence base supporting the efficacy of exercise and physical activity in the prevention and treatment of depression, including evidence supporting exercise as a monotherapy and adjunct to antidepressant medication and psychotherapies. We conclude the chapter by outlining challenges to prescribing exercise for depression and general recommendations for encouraging behavioral adoption for individuals suffering from depression.

Magnesium supplementation beneficially affects depression in adults with depressive disorder: a systematic review and meta-analysis of randomized clinical trials

Background

The findings from randomized clinical trials (RCTs) examining the effect of magnesium supplementation on depression are inconsistent. We decided to conduct a meta-analysis that summarizes all the evidence on the impact of magnesium supplementation on depression scores in adults with depressive disorder.

Methods

We conducted a systematic search in the online databases using all related keywords up to July 2023. We included all randomized clinical trials examining the effect of magnesium, in contrast to placebo, on depression scores.

Results

Finally, seven clinical trials were included in this systematic review, building up a total sample size of 325 individuals with ages ranging from 20 to 60 years on average. These RCTs resulted in eight effect sizes. Our findings from the meta-analysis showed a significant decline in depression scores due to intervention with magnesium supplements [standardized mean difference (SMD): -0.919, 95% CI: -1.443 to -0.396, p = 0.001].

Conclusion

Our review suggests that magnesium supplementation can have a beneficial effect on depression. Future high-quality RCTs with larger sample sizes must be run to interpret this effect of magnesium on depression in clinical settings.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=447909.

"Heads Up" for Creatine Supplementation and its Potential Applications for Brain Health and Function

There is emerging interest regarding the potential beneficial effects of creatine supplementation on indices of brain health and function. Creatine supplementation can increase brain creatine stores, which may help explain some of the positive effects on measures of cognition and memory, especially in aging adults or during times of metabolic stress (i.e., sleep deprivation). Furthermore, creatine has shown promise for improving health outcome measures associated with muscular dystrophy, traumatic brain injury (including concussions in children), depression, and anxiety. However, whether any sex- or age-related differences exist in regard to creatine and indices of brain health and function is relatively unknown. The purpose of this narrative review is to: (1) provide an up-to-date summary and discussion of the current body of research focusing on creatine and indices of brain health and function and (2) discuss possible sex- and age-related differences in response to creatine supplementation on brain bioenergetics, measures of brain health and function, and neurological diseases.

Prevention of seminal vesicle damage by Mucuna pruriens var. pruriens seed extract in chronic unpredictable mild stress mice

CONTEXT

Thai Mucuna pruriens (L.) DC. var. pruriens (Fabaceae) or T-MP seed extract has been shown to improve sexual performance and sperm quality.

OBJECTIVE

This study investigates the preventive effects of T-MP against seminal vesicle damage, apoptotic and Nrf2 protein expression in mice under chronic unpredictable mild stress (CUMS).

MATERIALS AND METHODS

Forty-eight male ICR mice were divided into four groups: control, CUMS, T-MP300 + CUMS and T-MP600 + CUMS. Mice in control and CUMS groups received distilled water, while those in treated groups were pretreated with T-MP extract (300 or 600 mg/kg BW) for 14 consecutive days. The CMUS and co-treated groups were exposed to one random stressor (of 12 total) each day for 43 days. Components and histopathology of the seminal vesicle were examined, along with localization of androgen receptor (AR) and caspase 3. Expression of seminal AR, tyrosine phosphorylated (TyrPho), heat shock protein 70 (Hsp70), caspases (3 and 9) and nuclear factor erythroid 2-related factor 2 (Nrf2) proteins was investigated.

RESULTS

T-MP extract at a dose of 600 mg/kg BW improved seminal epithelial damage and secretion of fluid containing essential substances and proteins in CUMS mice. It also increased the expression of AR and TyrPho proteins. Additionally, T-MP increased expression of Nrf2 and inhibited seminal vesicular apoptosis through the suppression of Hsp70 and caspase expression.

CONCLUSION

T-MP seeds have an antiapoptotic property in chronic stress seminal vesicle. It is possible to apply this extract for the enhancement of seminal plasma quality.

Discontinuation of antidepressant treatment: a retrospective cohort study on more than 20,000 participants

BACKGROUND

Factors influencing antidepressant treatment discontinuation are poorly understood. In the present study, we aimed to estimate the prevalence of antidepressant treatment discontinuation and identify demographic characteristics, psychiatric comorbidities, and specific side effects associated with treatment discontinuation.

METHODS

We leveraged data from the Australian Genetics of Depression Study (AGDS; N = 20,941) to perform a retrospective cohort study on antidepressant treatment discontinuation. Participants were eligible if they were over 18 years of age, had taken antidepressants in the past 4 years, and provided informed consent.

RESULTS

Among the ten antidepressants studied, the highest discontinuation rates were observed for Mirtazapine (57.3%) and Amitriptyline (51.6%). Discontinuation rates were comparable across sexes except for Mirtazapine, for which women were more likely to discontinue. The two most common side effects, reduced sexual function and weight gain, were not associated with increased odds of treatment discontinuation. Anxiety, agitation, suicidal thoughts, vomiting, and rashes were associated with higher odds for treatment discontinuation, as were lifetime diagnoses of PTSD, ADHD, and a higher neuroticism score. Educational attainment showed a negative (protective) association with discontinuation across medications.

CONCLUSIONS

Our study suggests that not all side effects contribute equally to discontinuation. Common side effects such as reduced sexual function and weight gain may not necessarily increase the risk of treatment discontinuation. Side effects linked to discontinuation can be divided into two groups, psychopathology related and allergy/intolerance.

Implementing digital mental health interventions at scale: one-year evaluation of a national digital CBT service in Ireland

BACKGROUND

In recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service).

METHODS

A retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models.

RESULTS

There were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (β = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (β = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen's d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%.

CONCLUSIONS

Efforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.

An open-label pilot trial assessing tolerability and feasibility of LSD microdosing in patients with major depressive disorder (LSDDEP1)

BACKGROUND

Globally, an estimated 260 million people suffer from depression [1], and there is a clear need for the development of new, alternative antidepressant therapies. In light of problems with the tolerability and efficacy of available treatments [2], a global trend is emerging for patients to self-treat depression with microdoses of psychedelic drugs such as lysergic acid diethylamide (LSD) and psilocybin [3]. Beyond anecdotal reports from those who self-medicate in this way, few clinical trials have evaluated this practice. In our recently published phase 1 study in healthy volunteers [4], we determined that LSD microdosing was relatively safe and well tolerated in that cohort. Furthermore, the data demonstrated that conducting such microdosing trials is broadly feasible, with excellent adherence and compliance to the regimen observed. In this open-label pilot trial of patients with major depressive disorder (LSDDEP1), we will test the tolerability and feasibility of an 8-week regimen of LSD microdosing in this patient group prior to a larger subsequent randomised controlled trial (LSDDEP2).

METHODS

Twenty patients meeting the DSM-5 criteria for major depressive disorder will receive an 8-week LSD microdosing treatment regimen. The treatment protocol will use a sublingual formulation of LSD (MB-22001) delivered twice per week under a titration schedule using a dose of 5-15 µg. Tolerability will be assessed by quantifying the percentage of participants who withdraw from the trial due to adverse events attributable to the treatment regimen, while feasibility will be assessed by quantifying the percentage of attended clinic visits once enrolled. To determine whether there is any antidepressant response to the LSD microdosing regimen, MADRS scores will be assessed at baseline and 2, 4, 6, and 8 weeks after the commencement of the regimen.

DISCUSSION

The results of LSDDEP1 will provide valuable information regarding the tolerability and feasibility of a proposed LSD microdosing regimen in patients with MDD. Such information is critically important to optimise trial design prior to commencing a subsequent and more resource-intensive randomised controlled trial.

TRIAL REGISTRATION

ANZCTR, ACTRN12623000486628. Registered on 12 May 2023.

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BACKGROUND

Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies.

METHODS

DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1.

SETTING

primary care general practices in southeast Queensland, Australia.

POPULATION

adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+.

INTERVENTION

RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs.

OUTCOME MEASURES

the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks.

SECONDARY OUTCOMES

at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs.

SAMPLE SIZE

653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity).

DISCUSSION

The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients.

TRIAL REGISTRATION

ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Factors associated with suicidal attempts in female patients with mood disorder

Aim

This study aims to establish a nomogram model to predict the relevance of SA in Chinese female patients with mood disorder (MD).

Method

The study included 396 female participants who were diagnosed with MD Diagnostic Group (F30-F39) according to the 10th Edition of Disease and Related Health Problems (ICD-10). Assessing the differences of demographic information and clinical characteristics between the two groups. LASSO Logistic Regression Analyses was used to identify the risk factors of SA. A nomogram was further used to construct a prediction model. Bootstrap re-sampling was used to internally validate the final model. The Receiver Operating Characteristic (ROC) curve and C-index was also used to evaluate the accuracy of the prediction model.

Result

LASSO regression analysis showed that five factors led to the occurrence of suicidality, including BMI (β = -0.02, SE = 0.02), social dysfunction (β = 1.72, SE = 0.24), time interval between first onset and first dose (β = 0.03, SE = 0.01), polarity at onset (β = -1.13, SE = 0.25), and times of hospitalization (β = -0.11, SE = 0.06). We assessed the ability of the nomogram model to recognize suicidality, with good results (AUC = 0.76, 95% CI: 0.71-0.80). Indicating that the nomogram had a good consistency (C-index: 0.756, 95% CI: 0.750-0.758). The C-index of bootstrap resampling with 100 replicates for internal validation was 0.740, which further demonstrated the excellent calibration of predicted and observed risks.

Conclusion

Five factors, namely BMI, social dysfunction, time interval between first onset and first dose, polarity at onset, and times of hospitalization, were found to be significantly associated with the development of suicidality in patients with MD. By incorporating these factors into a nomogram model, we can accurately predict the risk of suicide in MD patients. It is crucial to closely monitor clinical factors from the beginning and throughout the course of MD in order to prevent suicide attempts.

Illicit drug use is associated with lower bone mineral density and bone strength

Objectives

To evaluate the association of illicit drug use with bone mineral density (BMD) and hip geometric parameters at the narrow neck.

Methods

This is a cross-sectional matched cohort study conducted in the Hong Kong Chinese population. Associations with illicit drug use were estimated using linear regression for BMD (lumbar spine and femoral neck) and hip geometrical parameters (cross-sectional area [CSA], cross-sectional moment of inertia [CSMI], section modulus [SM], average cortical thickness [ACT] and BMD at the narrow neck) after adjusting for age, body mass index (BMI), smoking status, drinking status, physical activity, and history of antipsychotic and antidepressant use. Mean difference and 95% confidence intervals (95% CI) were calculated between 108 illicit drug users and 108 controls using an adjusted linear model and cluster-robust standard errors after matching by age and sex. The false discovery rate was used to correct for multiple testing.

Results

Illicit drug users had a significantly lower BMD (g/cm2) at the lumbar spine (mean difference: -0.062; 95% CI: -0.108 to -0.015), and femoral neck (mean difference: -0.058; 95% CI: -0.106 to -0.010) in the fully adjusted model. Illicit drug users also had a significantly lower CSA (mean difference: -0.238 cm2; 95% CI: -0.462 to -0.013), ACT (mean difference: -0.018 cm; 95% CI: -0.030 to -0.006) and BMD (mean difference: -0.070 g/cm2; 95% CI: -0.128 to -0.012) at the narrow neck.

Conclusions

Illicit drug use is associated with lower BMD and bone strength. Future studies evaluating the risk of illicit drug use with fragility fracture are warranted.

Suicidal ideation and suicide attempt following ketamine prescription in patients with treatment-resistant depression: a nation-wide cohort study

Ketamine, including esketamine, is an effective treatment for patients with treatment-resistant depression (TRD); however, its long-term efficacy in real-world populations remains poorly characterized. This is a retrospective cohort study using TriNetX US Collaborative Network, a platform aggregating electronic health records (EHRs) data from 93 million patients from 56 health care organizations in the US, and the study population includes 321,367 patients with a diagnosis of TRD who were prescribed relevant treatment in their EHRs. The prescription of ketamine (including esketamine) was associated with significant decreased risk of suicidal ideation compared to prescription of other common antidepressants: HR = 0.65 (95% CI: 0.53 - 0.81) at 1 day - 7 days, 0.78 (95% CI: 0.66 - 0.92) at 1 day - 30 days, 0.81 (95% CI: 0.70 - 0.92) at 1 day - 90 days, 0.82 (95% CI: 0.72 - 0.92) at 1 day - 180 days, and 0.83 (95% CI: 0.74 - 0.93) at 1 day - 270 days. This trend was especially robust among adults over 24 years of age, males, and White patients with TRD. No significant difference was observed for suicide attempts, except significantly increased risk for adolescents (aged 10-24) at 1 day - 30 days with HR = 2.22 (95% CI: 1.01-4.87). This study provides real-world evidence that ketamine has long-term benefits in mitigating suicidal ideation in patients with treatment-resistant depression. Future work should focus on optimizing dosage regimens for ketamine, understanding the mechanism, and the difference in various demographic subpopulations.

Experiences of psilocybin treatment for clinical conditions: A qualitative meta-synthesis

There is increasing clinical interest in the use of psilocybin. There is emerging evidence of the efficacy of psilocybin for the treatment of a range of clinical conditions. Mental health nurses have a unique set of skills for caring for people who are hallucinating. To expand these skills to meet the developing clinical interest in the therapeutic use of psilocybin, it is helpful to understand the experience from the perspective of the person being treated with psilocybin. A qualitative meta-synthesis was conducted to examine how those with psilocybin described their experiences to identify whether its effects are similar across different health conditions. Ten studies were included in the review. The health conditions studied were cancer, depression, HIV, substance use disorder, smoking cessation and trauma. The synthesis of findings identified three themes that were common across the studies despite the health condition: acceptance, connection and transformation. The review provides helpful insights into how people experience psilocybin and its effects on their health condition.

Apathy associated with antidepressant drugs: a systematic review

OBJECTIVES

Administration of antidepressant drugs - principally selective serotonin reuptake inhibitors (SSRIs) - may induce clinically significant 'apathy' which can affect treatment outcomes adversely. We aimed to review all relevant previous reports.

METHODS

We performed a PUBMED search of English-language studies, combining terms concerning psychopathology (e.g. apathy) and classes of antidepressants (e.g. SSRI).

RESULTS

According to certain inclusion (e.g. use of DSM/ICD diagnostic criteria) and exclusion (e.g. presence of a clinical condition that may induce apathy) criteria, 50 articles were eligible for review. Together, they suggest that administration of antidepressants - usually SSRIs - can induce an apathy syndrome or emotional blunting, i.e. a decrease in emotional responsiveness, to circumstances which would have triggered intense mood reactions prior to pharmacotherapy. The reported prevalence of antidepressant-induced apathy ranges between 5.8 and 50%, and for SSRIs ranges between 20 and 92%. Antidepressant-induced apathy emerges independently of diagnosis, age, and treatment outcome and appears dose-dependent and reversible. The main treatment strategy is dose reduction, though some data suggest the usefulness of treatment with olanzapine, bupropion, agomelatine or amisulpride, or the methylphenidate-modafinil-olanzapine combination.

CONCLUSION

Antidepressant-induced apathy needs careful clinical attention. Further systematic research is needed to investigate the prevalence, course, aetiology, and treatment of this important clinical condition.