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Laicher H, Int-Veen I, Woloszyn L, Wiegand A, Kroczek A, Sippel D, Leehr EJ, Lawyer G, Albasini F, Frischholz C, Mössner R, Nieratschker V, Rubel J, Fallgatter A, Ehlis AC, Rosenbaum D. In situ fNIRS measurements during cognitive behavioral emotion regulation training in rumination-focused therapy: A randomized-controlled trial. Neuroimage Clin 2023; 40:103525. [PMID: 37839195 PMCID: PMC10589893 DOI: 10.1016/j.nicl.2023.103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Repetitive negative thinking (RNT), including rumination, plays a key role in various psychopathologies. Although several psychotherapeutic treatments have been developed to reduce RNT, the neural correlates of those specific treatments and of psychotherapy in general are largely unknown. Functional near-infrared spectroscopy (fNIRS) offers the potential to investigate the neural correlates of psychotherapeutic techniques in situ. Therefore, in this study we investigated the efficacy and neural correlates of a fNIRS adapted Mindfulness-based Emotion Regulation Training (MBERT) for the treatment of depressive rumination in 42 subjects with major depressive disorder (MDD) in a cross-over designed randomized controlled trial. Using psychometric measures, subjective ratings and fNIRS, we analyzed in situ changes in depressive symptom severity, ruminative thoughts and cortical activity in the Cognitive Control Network (CCN). Our results show that MBERT is effective in treating depressive symptoms and rumination. On a neural level, we found consistently higher cortical activation during emotion regulation training compared to control trials in the bilateral inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). Furthermore, cortical oxygenation decreased from session to session in the bilateral DLPFC. The relevance of the results for the psychotherapeutic treatment of MDD as well as further necessary investigations are discussed.
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Affiliation(s)
- Hendrik Laicher
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany.
| | - Isabell Int-Veen
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Leonie Woloszyn
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; Max-Planck Institute of Psychiatry, Munich, Germany
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Daniel Sippel
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Elisabeth J Leehr
- Institute for Translational, University of Muenster, Muenster, Germany
| | - Glenn Lawyer
- Machine Learning Solutions, Luxembourg, Luxembourg
| | - Francesco Albasini
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Christian Frischholz
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Rainald Mössner
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Julian Rubel
- Psychotherapy Research Unit, Department of Psychology, Osnabrueck University, Osnabrueck, Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
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Lineham A, Avila-Quintero VJ, Bloch MH, Dwyer J. The Relationship Between Acute Dissociative Effects Induced by Ketamine and Treatment Response in Adolescent Patients with Treatment-Resistant Depression. J Child Adolesc Psychopharmacol 2023; 33:20-26. [PMID: 36799961 DOI: 10.1089/cap.2022.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective: Ketamine has proven effective as a rapid-acting antidepressant agent. Several adult studies have investigated the association between ketamine's acute dissociative effects and depression response, but no studies have examined the association in adolescents with treatment-resistant depression (TRD). Methods: We conducted a secondary data analysis of 16 adolescent participants who participated in a randomized, single-dose, midazolam-controlled crossover trial of ketamine in adolescents with depression. We examined the association between the acute dissociative symptoms (measured at 60 minutes following start of infusion using the Clinician-Administered Dissociative States Scale [CADSS], and its three subscales: depersonalization, derealization, amnesia) and response and depression symptom improvement at 1'day (using the Montgomery-Åsberg Depression Rating Scale). Results: Within the ketamine group, there were no significant associations between dissociation symptoms or CADSS subscale scores and magnitude of depression symptom improvement or likelihood of ketamine response. When receiving midazolam, there was no significant association between overall dissociation symptoms and magnitude or likelihood of response of depressive symptoms. Higher levels of symptoms on the 'depersonalization' CADSS subscale when receiving midazolam were associated with less improvement in depression symptoms at 1 day following infusion. Conclusions: In contrast to some adult literature, the current data do not show a relationship between acute dissociative effects and antidepressant response to ketamine in pediatric patients with TRD. Interpretation may be limited by the small sample size, reducing the power to detect small or medium associations. Future research should utilize larger samples to more definitively measure the magnitude of association between acute dissociative symptoms and later antidepressant response to ketamine and to assess the relationship to trial design (e.g., crossover vs. parallel trial, comparison condition utilized and number of infusions) within both adult and pediatric populations. ClinicalTrials.gov identifier: NCT02579928.
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Affiliation(s)
- Alice Lineham
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry and Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Dwyer
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Caroff SN. En garde! An Historical Note on the Nosology of Catalepsy. J Neuropsychiatry Clin Neurosci 2022; 34:93-94. [PMID: 35113667 DOI: 10.1176/appi.neuropsych.20120304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stanley N Caroff
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia; and University of Pennsylvania Perelman School of Medicine, Philadelphia
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Abstract
Light therapy has become established as an evidence-based treatment for Seasonal Affective Disorder. Light impacts the timing and stability of circadian rhythms as expressed in sleep, mood, alertness, and cognition. Forty years of clinical trials and open treatment have led to guidelines for patient selection, using light alone or in combination with antidepressants (or lithium for bipolar depression). Mood and sleep disturbances can also respond to adjunct light therapy in a broader set of psychiatric, neurologic and medical illnesses. We specify criteria for choice of treatment devices: optimum dose (10,000 lux), spectrum (white light), exposure duration (30-60 minutes) and timing (early morning). Protocol adjustment requires continual monitoring with attention to rate of improvement and management of potential side effects.
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Affiliation(s)
- Anna Wirz-Justice
- Centre for Chronobiology, Transfaculty Research Platform, Molecular and Cognitive Neurosciences, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - And Michael Terman
- Department of Psychiatry, Columbia University, and Center for Environmental Therapeutics, New York, USA
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5
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Kreppke JN, Cody R, Faude O, Gerber M. [Enjoying Sports and Movement in Mental Illness]. Praxis (Bern 1994) 2022; 110:200-204. [PMID: 35291865 DOI: 10.1024/1661-8157/a003830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Enjoying Sports and Movement in Mental Illness Abstract. Sports and exercise therapy is an effective complemant in the treatment of major depression. The recommendations of at least 150 minutes of moderate or 75 minutes of intensive physical activity per week should be met to achieve positive effects of physical activity. In addition, individual needs and the physical health conditions must be considered in the planning and implementation, so that exercise will be enjoyed in the long term.
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Affiliation(s)
- Jan-Niklas Kreppke
- Abteilung Bewegungs- und Trainingswissenschaften, Departement für Sport, Bewegung und Gesundheit, Universität Basel, Basel
| | - Robyn Cody
- Abteilung Sport und psychische Gesundheit, Departement für Sport, Bewegung und Gesundheit, Universität Basel, Basel
| | - Oliver Faude
- Abteilung Bewegungs- und Trainingswissenschaften, Departement für Sport, Bewegung und Gesundheit, Universität Basel, Basel
| | - Markus Gerber
- Abteilung Sport und psychische Gesundheit, Departement für Sport, Bewegung und Gesundheit, Universität Basel, Basel
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Cano M, Cardoner N. Biomarkers of response to rapid-acting antidepressants. Eur Neuropsychopharmacol 2021; 53:101-103. [PMID: 34536713 DOI: 10.1016/j.euroneuro.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Cano
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Narcís Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Abstract
Altered behavioral rhythms are a fundamental diagnostic feature of mood disorders. Patients report worse subjective sleep and objective measures confirm this, implicating a role for circadian rhythm disruptions in mood disorder pathophysiology. Molecular clock gene mutations are associated with increased risk of mood disorder diagnosis and/or severity of symptoms, and mouse models of clock gene mutations have abnormal mood-related behaviors. The mechanism by which circadian rhythms contribute to mood disorders remains unknown, however, circadian rhythms regulate and are regulated by various biological systems that are abnormal in mood disorders and this interaction is theorized to be a key component of mood disorder pathophysiology. A growing body of evidence has begun defining how the interaction of circadian and neurotransmitter systems influences mood and behavior, including the role of current antidepressants and mood stabilizers. Additionally, the hypothalamus-pituitary-adrenal (HPA) axis interacts with both circadian and monoaminergic systems and may facilitate the contribution of environmental stressors to mood disorder pathophysiology. The central role of circadian rhythms in mood disorders has led to the development of chronotherapeutics, which are treatments designed specifically to target circadian rhythm regulators, such as sleep, light, and melatonin, to produce an antidepressant response.
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Yang L, Yang X, Yang T, Wu X, Sun P, Zhu Y, Su Y, Gu W, Qiu H, Wang J, Chen J, Fang Y. The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Res 2021; 305:114205. [PMID: 34551381 DOI: 10.1016/j.psychres.2021.114205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
The relationship between thyroid function and depression has long been recognized, but little is known about the effect of thyroid function on the risk of readmission after hospitalization for major depressive disorder (MDD). This retrospective cohort study was aimed to explore the effect of thyroid function on psychiatric readmission after hospitalization for MDD. Data was derived from electronic medical records (EMR) of the Shanghai Mental Health Center (SMHC), Shanghai, China. Univariate and multivariate logistic regression analyses were conducted in subjects aged ≥ 18 years who had been hospitalized for MDD between January 1, 2007, and May 31, 2019. Of the 1803 eligible patients, 85 and 132 patients experienced psychiatric readmission within 90 days and 180 days after discharge respectively. Multivariate analyses showed that serum FT3 level (aOR=1.271; 95%CI=1.051-1.537) and comorbidity of thyroid disease (aOR=2,179; 95%CI=1.136-4.179) was independently associated with the risk of 90-day and 180-day readmission respectively. These findings indicated that high serum FT3 levels and comorbidity of thyroid disease could increase the risk of readmission after hospitalization for MDD. It is warranted to provide routine assessment and intervention of the thyroid function during the treatment of depression so as to prevent re-hospitalization.
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Affiliation(s)
- Lu Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaorui Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tao Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaohui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ping Sun
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yuncheng Zhu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yousong Su
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Wenjie Gu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hong Qiu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jianli Wang
- School of Epidemiology and Public Health, Department of Psychiatry, Faculty of Medicine & Institute of Mental Health Research, University of Ottawa, Ontario K1N 6N5, Canada
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510515, China.
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510515, China.
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Hieronymus F, Østergaard SD. Rating, berating or overrating antidepressant efficacy? The case of the Hamilton depression rating scale. Eur Neuropsychopharmacol 2021; 52:12-14. [PMID: 34153631 DOI: 10.1016/j.euroneuro.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fredrik Hieronymus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Søren D Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Denmark
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Braude M, Phan T, Con D, Woolley I, Sundram S, Clarke D, Dev A, Sievert W. Hepatitis C virus in people with serious mental illness: An analysis of the care cascade at a tertiary health service with a pilot 'identify and treat' strategy. Intern Med J 2021; 53:700-708. [PMID: 34719839 DOI: 10.1111/imj.15604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with serious mental illness (SMI) are underserved from a hepatitis C Virus (HCV) screening and treatment perspective. AIMS To examine the HCV care cascade in people with SMI and to pilot a supported HCV treatment integration program. METHODS HCV prevalence was retrospectively analysed from 4,492 consecutive individuals admitted to a tertiary hospital mental health service between January 2017 and December 2018. Sub-cohort analysis of screening patterns and predictors of seropositive infection was performed. Referral pathways and community care integration were analysed for HCV positive individuals, and a prospective community-based 'identify and treat' HCV program was assessed. RESULTS Screening for HCV had been performed in 18.6% (835/4,492) of the cohort. Seroprevalence was 4.6% (207/4,492). HCV seropositivity was associated with age > 40-years (OR = 9.30, CI 3.69-23.45, p <0.01), injecting drug use (IDU) (OR = 24.26, CI 8.99-65.43, p <0.01), and previous incarceration (OR = 12.26, 4.51-33.31, p <0.01). In a cohort of treatment-eligible individuals, 43.3% (90/208) had neither been referred to specialist services or general practitioners for HCV management. Amongst those referred to specialist services, 64.7% (57/88) did not attend scheduled follow-up, and 48.3% (15/31) of attendees were lost to follow-up. Through an intensified community access program, 10 people were successfully treated for HCV, though 22 could not be engaged. CONCLUSION People with SMI are underserved by traditional models of HCV healthcare. Intensified community-based support can partially bolster the treatment cascade, though investment in innovative screening and management strategies are required to achieve healthcare parity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael Braude
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Timothy Phan
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia
| | - Danny Con
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Australia
| | - Ian Woolley
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - Suresh Sundram
- Department of Mental Health, Monash Health, Melbourne, Australia.,Psychological Medicine, Monash University, Melbourne, Australia
| | - David Clarke
- Department of Mental Health, Monash Health, Melbourne, Australia.,Psychological Medicine, Monash University, Melbourne, Australia
| | - Anouk Dev
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - William Sievert
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
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Fuhr K, Meisner C, Broch A, Cyrny B, Hinkel J, Jaberg J, Petrasch M, Schweizer C, Stiegler A, Zeep C, Batra A. Efficacy of hypnotherapy compared to cognitive behavioral therapy for mild to moderate depression - Results of a randomized controlled rater-blind clinical trial. J Affect Disord 2021; 286:166-73. [PMID: 33725616 DOI: 10.1016/j.jad.2021.02.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/10/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Methodologically well-designed RCTs concerning the efficacy of Hypnotherapy in the treatment of Major Depression are lacking. The aim of this study was to determine whether Hypnotherapy (HT) is not inferior to Cognitive Behavioral Therapy (CBT), the gold-standard psychotherapy, in the percentage reduction of depressive symptoms, assessed in mild to moderate Major Depression (MD). METHODS This study reports the main results of a monocentric two-armed randomized-controlled rater-blind clinical trial. A total of 152 patients with MD were randomized to either CBT or HT receiving outpatient individual psychotherapy with 16 to 20 sessions for the duration of six months. The primary outcome was the mean percentage improvement in depressive symptoms assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) before and after treatment. RESULTS The difference in the mean percentage symptom reduction between HT and CBT was 2.8 (95% CI=-9.85 to 15.44) in the Intention-to-treat sample and 4.0 (95% CI=-9.27 to 17.27) in the Per Protocol sample (N=134). Concerning the pre-specified non-inferiority margin of -16.4, both results confirm the non-inferiority of HT to CBT. The results for the follow-ups six and twelve months after the end of the treatment support the primary results. LIMITATIONS For ethical reasons the trial did not include a control group without treatment; therefore we can only indirectly conclude that both treatment conditions are effective. CONCLUSION This is the first study to demonstrate that HT was not inferior to CBT in MD, while employing rigorous methodological standards.
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12
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Meyer T, Brunovsky M, Horacek J, Novak T, Andrashko V, Seifritz E, Olbrich S. Predictive value of heart rate in treatment of major depression with ketamine in two controlled trials. Clin Neurophysiol 2021; 132:1339-1346. [PMID: 33888426 DOI: 10.1016/j.clinph.2021.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/30/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Ketamine has been shown to be effective in treatment of episodes of major depressive disorder (MDD). This controlled study aimed to analyse the predictive and discriminative power of heart rate (HR) and heart rate variability (HRV) for ketamine treatment in MDD. METHODS In 51 patients, HR and HRV were assessed at baseline before and during ketamine infusion and 24 hours post ketamine infusion. Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess changes of depressive symptoms. A 30% or 50% reduction of symptoms after 24 hours or within 7 days was defined as response. A linear mixed model was used for analysis. RESULTS Ketamine infusion increased HR and HRV power during and after infusion. Responders to ketamine showed a higher HR during the whole course of investigation, including at baseline with medium effect sizes (Cohen's d = 0.47-0.67). Furthermore, HR and HRV power discriminated between responders and non-responders, while normalized low and high frequencies did not. CONCLUSION The findings show a predictive value of HR and HRV power for ketamine treatment. This further underlines the importance of the autonomous nervous system (ANS) and its possible malfunctions in MDD. SIGNIFICANCE The predictive power of HR and HRV markers should be studied in prospective studies. Neurophysiological markers could improve treatment for MDD via optimizing the choice of treatments.
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Affiliation(s)
- Torsten Meyer
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Martin Brunovsky
- National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Jiri Horacek
- National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Tomas Novak
- National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Veronika Andrashko
- National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Erich Seifritz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Sebastian Olbrich
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
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Nouri Saeidlou S, Kiani A, Ayremlou P. Association between Dietary Patterns and Major Depression in Adult Females: A Case-Control Study. J Res Health Sci 2021; 21:e00506. [PMID: 34024764 PMCID: PMC8957692 DOI: 10.34172/jrhs.2021.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Depression is one of the most common mental disorders. This study aimed to determine the association between dietary patterns and major depression in adult females.
Study design: A case-control study.
Methods: This study was conducted on adult females suffering from major depression within the age range from 19 to 65 years. The total participants of this study included 170 cases and 340 controls. Dietary intakes were collected using a 168-item validated semi-quantitative food-frequency questionnaire. Household food security was measured using a locally adapted Household Food Insecurity Access Scale. Moreover, the depression status of the adult females was assessed through a validated "Beck" questionnaire. Logistic regression was utilized to assess the association between dietary pattern scores and depression.
Results: The mean ±SD ages of the participants were 36.97 ±11.28 and 36.07 ±10.58 years in the case and control groups, respectively (P=0.374), and five major dietary patterns were extracted in this study. The odds ratio (OR) in the last adjusted model was (OR: 0.61; 95% CI: 0.46, 0.81); therefore, the "Healthy pattern" was significantly inversely associated with the odds of depression. Adherence to the "Western pattern" significantly increased depression by 29% (OR: 1.29; 95% CI: 1.06, 1.59). Furthermore, the "Traditional pattern" was positively associated with depression (OR: 1.16; 95% CI: 0.94, 1.43). There was no significant association between "Sugar and fast food" and "red meat and oils" dietary pattern and depression.
Conclusions: Healthy dietary pattern reduces the risk of depression in adult females; however, the western and traditional dietary patterns increases this risk.
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Affiliation(s)
- Sakineh Nouri Saeidlou
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Arezou Kiani
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Parvin Ayremlou
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Tobore TO. On maternal Post-Partum/Natal depression. A global underrecognized problem and the need for better Treatment strategies. Psychiatry Res 2020; 290:113163. [PMID: 32505925 DOI: 10.1016/j.psychres.2020.113163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Maternal Postpartum (PPD) or Postnatal Depression (PND) is believed to be the commonest medical complication postpartum. Evidence suggests a significantly higher prevalence of the disease compared to the often reported 10-15%. METHOD Studies were identified by accessing several databases including PubMed/Medline, PubMed Central, EBSCO, and PsycINFO. RESULTS Vitamin D (VD) deficiency, hormonal levels alteration (estrogen, progesterone, testosterone, oxytocin, and prolactin), thyroid dysfunction, and increased oxidative stress, play a critical role in PPD etiopathogenesis and pathophysiology. CONCLUSIONS Treatment strategies should include an integrated approach of antidepressants and psychotherapy, melatonin, diet, sleep improvement, exercise, VD and antioxidants supplementation, and economic and social support.
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Rao V, Bechtold K, McCann U, Roy D, Peters M, Vaishnavi S, Yousem D, Mori S, Yan H, Leoutsakos J, Tibbs M, Reti I. Low-Frequency Right Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression After Traumatic Brain Injury: A Randomized Sham-Controlled Pilot Study. J Neuropsychiatry Clin Neurosci 2020; 31:306-318. [PMID: 31018810 DOI: 10.1176/appi.neuropsych.17110338] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. METHODS In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfunction. Exploratory analyses of diffusion tensor imaging pre- and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. RESULTS Small (Hedge's g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. CONCLUSIONS These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.
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Affiliation(s)
- Vani Rao
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Kathleen Bechtold
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Una McCann
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Durga Roy
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Matthew Peters
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Sandeep Vaishnavi
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - David Yousem
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Susumu Mori
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Haijuan Yan
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Jeannie Leoutsakos
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Michael Tibbs
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
| | - Irving Reti
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Rao, McCann, Roy, Peters, Yan, Leoutsakos, Tibbs, Reti); the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore (Bechtold); the Neuropsychiatric Clinic at Carolina Partners and Departments of Community and Family Medicine and Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C. (Vaishnavi); and the Department of Radiology, Johns Hopkins University School of Medicine, Baltimore (Mori, Yousem)
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16
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Piechaczek CE, Greimel E, Feldmann L, Pehl V, Allgaier AK, Frey M, Freisleder FJ, Halldorsdottir T, Binder EB, Ising M, Schulte-Körne G. Interactions between FKBP5 variation and environmental stressors in adolescent Major Depression. Psychoneuroendocrinology 2019; 106:28-37. [PMID: 30953930 DOI: 10.1016/j.psyneuen.2019.03.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Major Depression (MD) results from a complex interplay between environmental stressors and biological factors. Previous studies in adults have shown that adverse life events interact with genetic variation in FKBP5, a gene implicated in the stress-response system, to predict depressive symptoms and MD. This is the first study to investigate interactions between FKBP5 variants and a range of environmental stressors in adolescents with a clinical diagnosis of MD. METHOD 148 male and female adolescents with MD and 143 typically developing (TD) controls (13-18 years) were included in the present study. For self-reported environmental stressors, subjective severity was assessed to allow a classification of these factors as mild, moderate and severe. Sociodemographic stressors were assessed via parental-report. RESULTS With a heightened number of sociodemographic, moderate and total number of stressors, participants carrying at least one copy of the FKBP5 CATT haplotype or at least one minor allele of various FKBP5 SNPs had the highest risk for being in the MD group. No genetic main effects were found. Sociodemographic stressors as well as self-reported mild, moderate, and severe stressors were more common in depressed than in TD adolescents. CONCLUSION This is the first study to show interactions between genetic variation in FKBP5 and environmental stressors in a sample of clinically depressed adolescents. The current study provides important starting-points for preventive efforts and highlights the need for a fine-grained analysis of different forms and severities of environmental stressors and their interplay with genetic variation for understanding the complex etiology of (youth) MD.
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Świechowski R, Jeleń A, Mirowski M, Talarowska M, Gałecki P, Pietrzak J, Wodziński D, Balcerczak E. Estimation of CYP3A4*1B single nucleotide polymorphism in patients with recurrent Major Depressive Disorder. Mol Genet Genomic Med 2019; 7:e669. [PMID: 31025537 PMCID: PMC6565542 DOI: 10.1002/mgg3.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/04/2019] [Indexed: 12/05/2022] Open
Abstract
Background Major depression is the most common mental illness in the world. Failures in treatment may occur due to the presence of a subtype of depression called TRD (Treatment‐ Resistant Depression). CYP3A4 polymorphism (rs2740574) can increase the activity of Cytochrome P450 3A4, contributing to faster metabolism of xenobiotics and reduced response to treatment. The aim of the study was to assess the distribution of CYP3A4*1B in study and control group and to estimate the influence of particular genotypes on parameters such as: age at onset, severity of symptoms before treatment and on the effectiveness of therapy. Methods Total of 192 patients were enrolled in this study (102 patients suffering from recurrent Major Depression Disorder, 90 healthy blood donors). PCR Restriction Fragment Length Polymorphism method with MboII enzyme was performed. The presence of CYP3A4*1B allele was evaluated on the basis of agarose gel electrophoresis. Results There was a tendency in frequency of genotypes distribution in the study group in comparison with the control group (p = 0.050). There were no statistically significant differences in the distribution mutant allele among these two groups, but there was a tendency for mutant allele to occur more often in the study group (p = 0.050). No significant correlations were found between the specific genotype and the studied parameters: age at onset (p = 0.232), severity of the symptoms (p = 0.946), and efficacy of treatment (p = 0.882). Conclusion The study suggests that CYP3A4*1B polymorphism have no influence on the predisposition to depression, the severity of depressive symptoms and the efficiency of antidepressant therapy.
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Affiliation(s)
- Rafał Świechowski
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Jeleń
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Marek Mirowski
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Monika Talarowska
- Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland
| | - Jacek Pietrzak
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Damian Wodziński
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
| | - Ewa Balcerczak
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Lodz, Poland
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Nelson JC, Bickford D, Delucchi K, Fiedorowicz JG, Coryell WH. Risk of Psychosis in Recurrent Episodes of Psychotic and Nonpsychotic Major Depressive Disorder: A Systematic Review and Meta-Analysis. Am J Psychiatry 2018; 175:897-904. [PMID: 29792050 DOI: 10.1176/appi.ajp.2018.17101138] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors conducted a systematic review and meta-analysis to determine whether the risk of psychosis is higher in past or future episodes in patients with major depression with psychotic features than in patients with nonpsychotic depression. METHOD PubMed, Embase, and PsycINFO were searched, and studies were selected that 1) identified patients with unipolar major depression, 2) made diagnoses of psychosis based on the presence of delusions or hallucinations, 3) characterized past or subsequent episodes as psychotic or nonpsychotic, and 4) were published in English. Two meta-analyses were then conducted using data from patients having index depressive episodes with or without psychosis at study entry to determine the risk of any prior or subsequent psychotic episode and the risk of psychosis in all episodes. RESULTS Twelve studies met the inclusion criteria, and altogether they included 546 psychotic and 1,583 nonpsychotic patients with unipolar depression. In seven of the studies, the risk ratio for a prior or subsequent psychotic episode in patients whose index depressive episode was psychotic compared with those whose index episode was nonpsychotic was 9.98 (95% CI=4.75, 20.94). In eight studies, the risk ratio for psychosis among all episodes of depression in the subgroups with psychotic and nonpsychotic index episodes was 7.24 (95% CI=5.03, 10.43). Differences in risk of psychosis between these subgroups remained robust when potential sources of heterogeneity were explored. CONCLUSIONS The findings support the hypothesis that psychotic depression runs true to form, and they support the distinction between psychotic and nonpsychotic depression. Because patients with psychotic depression are at high risk for psychosis in future episodes, determination of effective preventive treatments is imperative.
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Affiliation(s)
- J Craig Nelson
- From the Department of Psychiatry, University of California, San Francisco; and the Department of Psychiatry, University of Iowa, Iowa City
| | - David Bickford
- From the Department of Psychiatry, University of California, San Francisco; and the Department of Psychiatry, University of Iowa, Iowa City
| | - Kevin Delucchi
- From the Department of Psychiatry, University of California, San Francisco; and the Department of Psychiatry, University of Iowa, Iowa City
| | - Jess G Fiedorowicz
- From the Department of Psychiatry, University of California, San Francisco; and the Department of Psychiatry, University of Iowa, Iowa City
| | - William H Coryell
- From the Department of Psychiatry, University of California, San Francisco; and the Department of Psychiatry, University of Iowa, Iowa City
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Abstract
Purpose of review The present review will provide an overview of the neurobiology, epidemiology, clinical impact, and treatment of cannabis use disorder (CUD) in mood disorders. Recent findings Patients with mood disorders including major depressive disorder (MDD) and bipolar disorder (BD) have higher rates of cannabis use, and CUD compared to the general population. Reasons for this association are not clear, nor are the putative therapeutic effects of cannabis use, or its components delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in these illnesses. The evidence surrounding treatments for patients with this comorbidity is lacking, with more support for psychotherapeutic treatments compared with pharmacological treatments. Summary Cannabis use may be associated mood disorders, but more research is needed to increase our understanding of the mechanisms for this association, and to develop more effective treatments for this comorbidity.
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Brunette MF, Pratt SI, Bartels SJ, Scherer EA, Sigmon SC, Ferron JC, Santos M, Williams GE, Kosydar S, Wolfe RS, Lotz D, Capuchino K. Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries With Mental Illness. Psychiatr Serv 2018; 69:274-280. [PMID: 29137560 DOI: 10.1176/appi.ps.201700245] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Medicaid beneficiaries with severe mental illnesses are a financially disadvantaged group with high rates of smoking and poor cessation outcomes. This study examined whether abstinence-contingent monetary incentives improved outcomes when added to cessation treatments at community mental health centers: prescriber visit for pharmacotherapy only (PV only), prescriber visit and facilitated quitline (PV+Q), and prescriber visit and telephone cognitive-behavioral therapy (PV+CBT). METHODS During 2012-2015, a total of 1,468 adult, daily smoking Medicaid beneficiaries with mental illnesses received Web-based motivational tobacco education. Eligible participants who wanted cessation treatment (N=661) were randomly assigned to treatment with or without abstinence-contingent incentives for four weeks after a quit attempt and assessed for biologically verified abstinence at three, six, nine, and 12 months. To examine intervention effect on abstinence over time, logistic generalized linear models estimated with generalized estimating equations were used, with missing observations imputed as smoking. RESULTS Participants included smokers with schizophrenia disorders (N=148), bipolar disorder (N=150), major depressive disorder (N=158), and anxiety and other disorders (N=205). There was no significant effect of intervention (PV only, PV+Q, and PV+CBT). However, participants who received monetary incentives were more likely to be abstinent from smoking over time (adjusted odds ratio [AOR]=1.77, p=.009). Post hoc comparisons indicated greater abstinence at 12 months in PV+Q with incentives than in PV+Q without incentives (14% versus 4% abstinent, AOR=3.94, p=.014). Treatment participation and cessation outcomes did not differ significantly between diagnostic groups. CONCLUSIONS Abstinence-contingent incentives improved cessation outcomes among financially disadvantaged smokers with mental illness receiving tobacco treatment at community mental health centers.
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Affiliation(s)
- Mary F Brunette
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Sarah I Pratt
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Stephen J Bartels
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Emily A Scherer
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Stacey C Sigmon
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Joelle C Ferron
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Meghan Santos
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Gail E Williams
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Samuel Kosydar
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Rosemarie S Wolfe
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Doris Lotz
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Kelley Capuchino
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
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Jelodar G, Javid Z, Sahraian A, Jelodar S. Saffron improved depression and reduced homocysteine level in patients with major depression: A Randomized, double-blind study. Avicenna J Phytomed 2018; 8:43-50. [PMID: 29387573 PMCID: PMC5787996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives: A correlation between hyperhomocysteinemia, and depression has been reported. Saffron (Crocus sativus) is recommended for treatment of depression; hence, in this study the effect of co-administration of saffron and fluoxetine on plasma homocysteine and depression was evaluated. Material and methods: This was a 4-week randomized and double-blind clinical trial which was conducted from March 2013 to February 2014. In this trial, 40 male and females (20-55 years old) diagnosed with severe depression were selected and following filing the Beck form, were randomly divided into two groups. Experimental group was treated with fluoxetine 20 mg/day and saffron 30 mg /day and the control group received placebo and fluoxetine 20 mg/day for four weeks. Before treatment and at the end of the study, fasting blood samples were collected. For females, blood samples were collected on the third day of their menstrual cycle. Results: A significant reduction of homocysteine levels was observed in both sex in the experimental group compared to before treatment (p<0.04), while no such significant change was observed in the control group. A Beck questionnaire value showed lower level in both groups on the last day of treatment as compared to before treatment. There was no significant difference between the two groups in Beck value neither before nor after treatment. Conclusion: Saffron has beneficial effects on depression and homocysteine level in patients with major depression.
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Affiliation(s)
| | - Zahra Javid
- Department of Physiology, Shiraz University, Shiraz,Iran
| | - Ali Sahraian
- Research Center for psychiatry and Behavior Science, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Jelodar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Marshe VS, Maciukiewicz M, Rej S, Tiwari AK, Sibille E, Blumberger DM, Karp JF, Lenze EJ, Reynolds CF, Kennedy JL, Mulsant BH, Müller DJ. Norepinephrine Transporter Gene Variants and Remission From Depression With Venlafaxine Treatment in Older Adults. Am J Psychiatry 2017; 174:468-475. [PMID: 28068779 DOI: 10.1176/appi.ajp.2016.16050617] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The primary objective of this study was to investigate five putatively functional variants of the norepinephrine transporter (SLC6A2, NET) and serotonin transporter (SLC6A4, SERT) genes and remission in depressed older adults treated with venlafaxine. A secondary objective was to analyze 17 other variants in serotonergic system genes (HTR1A, HTR2A, HTR1B, HTR2C, TPH1, TPH2) potentially involved in the mechanism of action of venlafaxine. METHOD The sample included 350 adults age 60 or older with DSM-IV-defined major depressive disorder and a score of at least 15 on the Montgomery-Åsberg Depression Rating Scale (MADRS). Participants received protocolized treatment with open-label venlafaxine, up to 300 mg/day for approximately 12 weeks, as part of a three-site clinical trial. Each individual was genotyped for 22 polymorphisms in eight genes, which were tested for association with venlafaxine remission (a MADRS score ≤10) and changes in MADRS score during treatment. RESULTS After adjusting for multiple comparisons, NET variant rs2242446 (T-182C) was significantly associated with remission (odds ratio=1.66, 95% CI=1.13, 2.42). Individuals with the rs2242446 C/C genotype were more likely to remit (73.1%) than those with either the C/T (51.8%) or the T/T genotype (47.3%). Individuals with the C/C genotype also had a shorter time to remission than those with the C/T or T/T genotypes and had a greater percentage change in MADRS score from baseline to end of treatment (up to week 12). CONCLUSIONS NET rs2242446/T-182C may serve as a biomarker to predict the likelihood of remission with venlafaxine in older adults with major depression. These findings may help to optimize antidepressant outcomes in older adults.
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Affiliation(s)
- Victoria S Marshe
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Malgorzata Maciukiewicz
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Soham Rej
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Arun K Tiwari
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Etienne Sibille
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Daniel M Blumberger
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Jordan F Karp
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Eric J Lenze
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Charles F Reynolds
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - James L Kennedy
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Benoit H Mulsant
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
| | - Daniel J Müller
- From the Institute of Medical Science, University of Toronto, Toronto; the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto; the Department of Psychiatry, McGill University, Montreal; the Department of Psychiatry and the Department of Pharmacology, University of Toronto, Toronto; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Geriatric Research Education and Clinical Center, VA Pittsburgh Health System, Pittsburgh; and the Healthy Mind Lab, Department of Psychiatry, Washington University, St. Louis
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Abstract
Hoarding disorder (HD) was originally conceptualized as a subcategory of obsessive compulsive disorder (OCD), and numerous studies have in fact focused exclusively on investigating the comorbidity between OCD and HD. Hoarding behavior can nevertheless also be found in other clinical populations and in particular in patients with eating disorders (ED), anxiety disorders (AD), major depression (MD), and psychotic disorders (PD). The current study was carried out with the aim of investigating, using a validated instrument such as the Saving Inventory-Revised (SI-R), the presence of HD symptoms in patients diagnosed with ED, AD, MD, and PD. Hoarding symptomatology was also assessed in groups of self-identified hoarders and healthy controls. The results revealed that 22.5% of the ED patients exceeded the cut-off for the diagnosis of HD, followed by 7.7% of the patients with MD, 7.4% of the patients with AD, and 5.9% of the patients with PD. The patients with ED had significantly higher SI-R scores than the other groups in the Acquisition and Difficulty Discarding scales while the AD, MD, and PD patients were characterized exclusively by Difficulty Discarding. These data suggest to clinicians that hoarding symptoms should be assessed in other types of patients and especially in those affected by Bulimia and Binge eating.
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Affiliation(s)
- Caterina Novara
- Department of General Psychology, University of Padova Padova, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova Padova, Italy
| | | | - Ezio Sanavio
- Department of General Psychology, University of Padova Padova, Italy
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Abstract
Objective: Temperament and mental illness have been linked to the same systems of behavioral regulation. A temperament model, carefully structured to respond to subtle differences within systems of behavior regulation, should exhibit distinct temperament patterns in the presence of mental illness. Previous comparisons of temperament profiles in mental disorders used mostly emotionality-related traits. In contrast, the Functional Ensemble of Temperament (FET) model differentiates not only between emotionality traits, but also between traits related to physical, verbal, and mental aspects of behavior and maps 12 functional aspects of behavior to temperament traits as well as to symptoms of mental illnesses. This article reports on the coupling of sex, age, and temperament traits with Major Depression (MD) using the FET framework. Method: Intake records of 467 subjects, ages 17-24, 25-45, 46-65, 66-84 were examined, with temperament assessed by the Structure of Temperament Questionnaire (based on the FET). Results: The presence of MD was associated with changes in mean temperament scores on 9 of the 12 traits. The results were in line with the DSM-5 criteria of fatigue (patients with MD reported a significant decrease in three types of endurance - motor-physical, social-verbal, and mental), of psychomotor retardation (a significant decrease in physical and social-verbal tempo) and of worthlessness (as low Self-Confidence). The results also showed that three new symptoms, high Impulsivity, high Neuroticism, and diminished Plasticity, should be considered as depressive symptoms in future versions of the DSM. As a significant negative result, no interaction of age or sex (with the exception of the Self-Confidence scale) with MD was found for temperament traits. Conclusion: The value of differentiating between physical, social, and mental aspects of behavior is demonstrated in the differential effects of major depression and gender. The value of differentiating between endurance, dynamical and orientation-related aspects of behavior is also demonstrated. The deleterious impact of MD on temperament scores appeared to be similar across all age groups. The appearance of high impulsivity, neuroticism, and low plasticity deserve further study as associated factors in future versions of the DSM/ICD.
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Affiliation(s)
- Irina N Trofimova
- Collective Intelligence Laboratory, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton ON, Canada
| | - William Sulis
- Collective Intelligence Laboratory, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton ON, Canada
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25
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Sikora M, Heffernan J, Avery ET, Mickey BJ, Zubieta JK, Peciña M. Salience Network Functional Connectivity Predicts Placebo Effects in Major Depression. Biol Psychiatry Cogn Neurosci Neuroimaging 2016; 1:68-76. [PMID: 26709390 PMCID: PMC4689203 DOI: 10.1016/j.bpsc.2015.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent neuroimaging studies have demonstrated resting-state functional connectivity (rsFC) abnormalities among intrinsic brain networks in Major Depressive Disorder (MDD); however, their role as predictors of treatment response has not yet been explored. Here, we investigate whether network-based rsFC predicts antidepressant and placebo effects in MDD. METHODS We performed a randomized controlled trial of two weeklong, identical placebos (described as having either "active" fast-acting, antidepressant effects or as "inactive") followed by a ten-week open-label antidepressant medication treatment. Twenty-nine participants underwent a rsFC fMRI scan at the completion of each placebo condition. Networks were isolated from resting-state blood-oxygen-level-dependent signal fluctuations using independent component analysis. Baseline and placebo-induced changes in rsFC within the default-mode, salience, and executive networks were examined for associations with placebo and antidepressant treatment response. RESULTS Increased baseline rsFC in the rostral anterior cingulate (rACC) within the salience network, a region classically implicated in the formation of placebo analgesia and the prediction of treatment response in MDD, was associated with greater response to one week of active placebo and ten weeks of antidepressant treatment. Machine learning further demonstrated that increased salience network rsFC, mainly within the rACC, significantly predicts individual responses to placebo administration. CONCLUSIONS These data demonstrate that baseline rsFC within the salience network is linked to clinical placebo responses. This information could be employed to identify patients who would benefit from lower doses of antidepressant medication or non-pharmacological approaches, or to develop biomarkers of placebo effects in clinical trials.
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Affiliation(s)
- Magdalena Sikora
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Heffernan
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erich T. Avery
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Brian J. Mickey
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jon-Kar Zubieta
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Marta Peciña
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Zimmermann J, Löffler-Stastka H, Huber D, Klug G, Alhabbo S, Bock A, Benecke C. Is It All about the Higher Dose? Why Psychoanalytic Therapy Is an Effective Treatment for Major Depression. Clin Psychol Psychother 2015; 22:469-87. [PMID: 25196642 DOI: 10.1002/cpp.1917] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/08/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023]
Abstract
UNLABELLED Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. KEY PRACTITIONER MESSAGE Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.
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Affiliation(s)
| | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München-Harlaching, Munich, Germany
| | - Günther Klug
- Department of Psychosomatic Medicine, Technical University Munich, Munich, Germany
| | - Sarah Alhabbo
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Astrid Bock
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
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27
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Fishbain DA, Cole B, Lewis JE, Gao J. Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review. Pain Med 2014; 15:1522-39. [PMID: 25139618 DOI: 10.1111/pme.12448] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this evidence-based structured review was to determine if there is consistent evidence that pain interferes with achieving antidepressant treatment response/remission of depression in patients with depression and pain. METHODS After exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined herein after. The percentage of studies supporting/not supporting each hypothesis was calculated. The strength and consistency of the evidence for each hypothesis were rated according to the Agency for Health Care Research and Quality (AHRQ) guidelines. RESULTS For the first hypothesis (pretreatment pain levels will predict antidepressant depression response), nine out of 10 (90%) studies supported it. For the second hypothesis (treatment decreases in pain will be associated with antidepressant depression response), two out of two (100%) studies supported it. For the third hypothesis (pretreatment pain levels will predict antidepressant depression remission), six out of six (100%) studies supported it. For the fourth hypothesis (treatment decreases in pain will be associated with antidepressant depression remission), five out of five (100%) supported it. Utilizing these percentages and AHRQ guidelines, hypotheses 1, 3, and 4 received an A rating for consistency of studies in supporting them. A consistency rating for hypothesis 2 could not be generated because of too few studies in that group. CONCLUSIONS Consistent evidence was found that antidepressant treatment of depression in patients with depression and pain can be negatively impacted by pain for achieving depression response/remission. However, the overall number of studies supporting each hypothesis was small. In addition, several potential confounders of the results of this study were identified.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA; The Rosomoff Comprehensive Pain Center, Douglas Gardens Hospital, Miami, Florida, USA
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28
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Sani G, Napoletano F, Forte AM, Kotzalidis GD, Panaccione I, Porfiri GM, Simonetti A, Caloro M, Girardi N, Telesforo CL, Serra G, Romano S, Manfredi G, Savoja V, Tamorri SM, Koukopoulos AE, Serata D, Rapinesi C, Casale AD, Nicoletti F, Girardi P. The wnt pathway in mood disorders. Curr Neuropharmacol 2012; 10:239-53. [PMID: 23449817 PMCID: PMC3468878 DOI: 10.2174/157015912803217279] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/13/2012] [Accepted: 03/24/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To review the evidence of the involvement of the Wnt signalling pathway in mood disorders and in the action of drugs used to treat these disorders. METHODS We performed a careful PubMed search using as keywords all possible terms relevant to the Wnt pathway and crossing them with each of four areas, i.e., developmental effects, behavioural effects, mood disorders, and drugs used in their treatment. Papers were selected on the basis of their content and their data used for discussion. RESULTS Neurodevelopmental and behavioural data point to the possibility of involvement of the Wnt pathway in the pathophysiology of mood disorders. Clinical and post-mortem data are not sufficient to corroborate a definite role for Wnt alterations in any mood disorder. Combining genetic and pharmacological data, we may state that glycogen synthase kinase is the key molecule in bipolar disorder, as it is connected with many other signalling pathways that were shown to be involved in mood disorders, while Wnt molecules in the hippocampus appear to be mainly involved in depressive disorders. CONCLUSIONS Altered Wnt signalling may play a role in the pathophysiology of mood disorders, although not a central one. It is premature to draw conclusions regarding the possible usefulness of Wnt manipulations in the treatment of mood disorders.
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Affiliation(s)
- Gabriele Sani
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | - Flavia Napoletano
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Alberto Maria Forte
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- NEUROMED, Pozzilli, Isernia, Italy
| | - Giorgio D Kotzalidis
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Isabella Panaccione
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- NEUROMED, Pozzilli, Isernia, Italy
| | - Giulio Maria Porfiri
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Alessio Simonetti
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | - Matteo Caloro
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Nicoletta Girardi
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Carla Ludovica Telesforo
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Giulia Serra
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | - Silvia Romano
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Giovanni Manfredi
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Valeria Savoja
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Stefano Maria Tamorri
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Alexia E Koukopoulos
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | - Daniele Serata
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Chiara Rapinesi
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
- Department of Neuropsychiatry, Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy
| | - Antonio Del Casale
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
| | - Ferdinando Nicoletti
- NEUROMED, Pozzilli, Isernia, Italy
- Department of Neuropharmacology, Sapienza University, School of Medicine and Pharmacy, Rome, Italy
| | - Paolo Girardi
- NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant’Andrea Hospital, Rome, Italy
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Reierson GW, Guo S, Mastronardi C, Licinio J, Wong ML. cGMP Signaling, Phosphodiesterases and Major Depressive Disorder. Curr Neuropharmacol 2012; 9:715-27. [PMID: 22654729 PMCID: PMC3263465 DOI: 10.2174/157015911798376271] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 09/09/2010] [Accepted: 09/24/2010] [Indexed: 12/13/2022] Open
Abstract
Deficits in neuroplasticity are hypothesized to underlie the pathophysiology of major depressive disorder (MDD): the effectiveness of antidepressants is thought to be related to the normalization of disrupted synaptic transmission and neurogenesis. The cyclic adenosine monophosphate (cAMP) signaling cascade has received considerable attention for its role in neuroplasticity and MDD. However components of a closely related pathway, the cyclic guanosine monophosphate (cGMP) have been studied with much lower intensity, even though this signaling transduction cascade is also expressed in the brain and the activity of this pathway has been implicated in learning and memory processes. Cyclic GMP acts as a second messenger; it amplifies signals received at postsynaptic receptors and activates downstream effector molecules resulting in gene expression changes and neuronal responses. Phosphodiesterase (PDE) enzymes degrade cGMP into 5’GMP and therefore they are involved in the regulation of intracellular levels of cGMP. Here we review a growing body of evidence suggesting that the cGMP signaling cascade warrants further investigation for its involvement in MDD and antidepressant action.
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Yuan W, Williams BN. Monoarthritis Induced by Bupropion Hydrochloride. Psychopharmacol Bull 2011; 44:85-87. [PMID: 27738357 PMCID: PMC5044482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bupropion hydrochloride is an inhibitor of dopamine and norepinephrine, which is commonly prescribed for major depression, smoking cessation, and bipolar depression. Here we report a highly unusual case of bupropion induced knee monoarthritis in a bipolar depression patient. With bupropion XL 150 mg for 2 weeks, her left knee began to swell; at the third week, this condition was worsening. The aggravation of the left knee effusion stopped after the discontinuation of bupropion XL. The effusion and swelling disappeared after 15 ml of synovial fluid was drawn out and the effusion has never returned. Analysis of the synovial fluid showed noninflammatory effusion. Her left knee swelling was most likely due to angioedema caused by bupropion XL.
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Affiliation(s)
- Weiqing Yuan
- Drs. Yuan, MD, PhD, Psychiatry Trainee, Williams, MD, Psychiatry Specialist, Family Behavioral Health; Department of Psychiatry, Forsyth Medical Center, Winson-Salem, NC
| | - Barry N Williams
- Drs. Yuan, MD, PhD, Psychiatry Trainee, Williams, MD, Psychiatry Specialist, Family Behavioral Health; Department of Psychiatry, Forsyth Medical Center, Winson-Salem, NC
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31
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Zarkowski P, Navarro R, Pavlicova M, George MS, Avery D. The effect of daily prefrontal repetitive transcranial magnetic stimulation over several weeks on resting motor threshold. Brain Stimul 2010; 2:163-7. [PMID: 20161065 DOI: 10.1016/j.brs.2009.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The resting motor threshold (rMT) is an important factor in the selection of treatment intensity for patients receiving repetitive transcranial magnetic stimulation (rTMS). In many clinical studies to date, due to concerns about potential drift, the rMT has been routinely re-measured weekly or every fifth session. OBJECTIVE Our aim is to investigate whether ongoing treatment with rTMS affects the rMT, the degree of change, and whether frequent remeasurement is needed. METHODS Clinical data were drawn from 50 medication free patients receiving treatment for major depression with rTMS in a large U.S. NIH-sponsored multisite study. Four measurements of rMT were obtained including before and after the double blind phase, followed by weekly measurements during the open phase. Active treatment consisted of 75 four second trains of 10Hz stimulation applied over 37.5 minutes with the coil over the left DLPFC at 120% rMT. RESULTS For the group as a whole, there was no significant change in the rMT during a minimum of 2 weeks of treatment with prefrontal rTMS (p=0.911, one way ANOVA). The average within-subject coefficient of variation was 6.58%. On average the last rMT was 2.45% less than the baseline rMT (range 32.3% increase, 40.6% decrease). CONCLUSION Daily left prefrontal rTMS over several weeks as delivered in this trial does not cause systematic changes in rMT. While most subjects had <10% variance in rMT over time, 5 subjects had changes of approximately 20% from baseline, raising dosing and safety issues if undetected. We recommend that clinical trials of rTMS have periodic retesting of rMT, especially if the dose is at or near the edge of the TMS safety tables.
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Affiliation(s)
- Paul Zarkowski
- University of Washington, 325 Ninth Avenue, Seattle WA 98104-2499, USA.
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32
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Moreines JL, McClintock SM, Holtzheimer PE. Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review. Brain Stimul 2010; 4:17-27. [PMID: 21255751 DOI: 10.1016/j.brs.2010.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/07/2009] [Accepted: 01/14/2010] [Indexed: 12/15/2022] Open
Abstract
Electroconvulsive therapy (ECT) and ablative neurosurgical procedures are established interventions for treatment-resistant depression (TRD), but their use may be limited in part by neuropsychological adverse effects. Additional neuromodulation strategies are being developed that aim to match or exceed the efficacy of ECT/ablative surgery with a better neurocognitive side effect profile. In this review, we briefly discuss the neurocognitive effects of ECT and ablative neurosurgical procedures, then synthesize the available neurocognitive information for emerging neuromodulation therapies, including repetitive transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, vagus nerve stimulation, and deep brain stimulation. The available evidence suggests these procedures may be more cognitively benign relative to ECT or ablative neurosurgical procedures, though further research is clearly needed to fully evaluate the neurocognitive effects, both positive and negative, of these novel neuromodulation interventions.
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33
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Akizuki N, Okamura H, Akechi T, Nakano T, Yoshikawa E, Nakanishi T, Uchitomi Y. Clinical experience of the pharmacological treatment algorithm for major depression in advanced cancer patients: preliminary study. Int J Psychiatry Clin Pract 2002; 6:83-9. [PMID: 24931933 DOI: 10.1080/136515002753724072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Treatment of major depression in advanced cancer patients is often difficult because of their special characteristics. METHOD The authors developed a treatment algorithm for major depression in advanced cancer patients and report on their clinical experience using it. The applicability, tolerability, and clinical efficacy of the algorithm were evaluated in 95 advanced cancer patients with major depression. RESULTS The algorithm was not suitable for seven patients and was not used correctly in 14 cases. It was correctly applied to 74 patients (77%), 23 of whom dropped out for cancer-related reasons (deterioration of physical condition, transfer to other hospitals, cancer death). As for tolerability, 22 patients (43%) of the 51 dropped out of the antidepressant treatment regimen because of delirium due to deterioration of their physical condition, adverse effects of the antidepressant, etc. In the 29 cases that could be followed up, clinical efficacy was evaluated for 4 weeks, and improvement was observed in 22 cases (76%). CONCLUSION These preliminary findings suggest that use of the algorithm may be feasible, but that it requires some alterations to manage major depression in advanced cancer patients. (Int J Psych Clin Pract 2002; 6: 83-89).
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Bailly D, Beuscart R, Collinet C, Alexandre JY, Parquet PJ. Sex differences in the manifestations of depression in young people. A study of French high school students part I: Prevalence and clinical data. Eur Child Adolesc Psychiatry 1992; 1:135-145. [PMID: 29871406 DOI: 10.1007/bf02091899] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The first part of this study investigates the prevalence and clinical manifestations of major depressive episodes in young people. The sample for this investigation consisted of 744 high school students (439 males and 305 females), aged 14 to 23 years, and attending 15 high schools in the North of France. Assessment of major depressive episodes according to DSM-III-R criteria was performed by medical doctors using a semi-structured interview and by means of the French version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Thirty-two students (18 males and 14 females) were found to have a major depressive episode with a prevalence of 4.1% in males and 4.7% in females. However, the results also showed that the significant manifestations of major depression differed according to sex and suggested that manifestations of major depression in female young people might differ from those observed in adults more markedly than in males. This may explain that the diagnostic performance of the CES-D was found to be higher in males than in females and that the female prevalence of major depression was found to be lower than those usually obtained with adolescent-specific diagnostic criteria.
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Affiliation(s)
- D Bailly
- Child and Adolescent Psychiatry Department, University Hospital, USN B, 6 Rue du Professeur Laguesse, F-59000, Lille, France
| | - R Beuscart
- Informatics Department, Medical School, 1, Place de Verdun, F-59000, Lille, France
| | - C Collinet
- Department of School Health, Educational District of Lille, 1, Rue Claude Bernard, F-59000, Lille, France
| | - J Y Alexandre
- Psychiatry Department, Hospital of Lommelet, F-59350, Saint Andre, France
| | - Ph J Parquet
- Child and Adolescent Psychiatry Department, University Hospital, USN B, 6 Rue du Professeur Laguesse, F-59000, Lille, France
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35
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Bailly D, Beuscart R, Collinet C, Alexandre JY, Parquet PJ. Sex differences in the manifestations of depression in young people. A study of French high school students. Part II: Correlates and background factors. Eur Child Adolesc Psychiatry 1992; 1:146-155. [PMID: 29871407 DOI: 10.1007/bf02091900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The second part of this study investigates the correlates and background factors of major depression in young people. The study sample consisted of 744 high school students, (439 males and 305 females), aged 14 to 23 years, and attending 15 high schools in the North of France. Among them, 32 (18 males and 14 females) had a major depressive episode according to DSM-III-R criteria. Data were collected by means of a questionnaire devised for the study in order to investigate sociodemographic, behavioral, medical and environmental factors associated with depression. Antisocial behavior, more frequently found in males, was the only factor significantly differentiating male from female depressed students. On the other hand, school difficulties, health problems, impairments in interpersonal relationships and family history disorders were most often found significantly associated with major depression in males but not in females. According to these findings, the authors examine the concept of "masked depression" and advance some hypotheses about the reasons why major depression in young people is so often underdiagnosed.
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Affiliation(s)
- D Bailly
- Child and Adolescent Psychiatry Department, University Hospital, USN B, 6 Rue du Professeur Laguesse, F-59000, Lille, France
| | - R Beuscart
- Informatics Department, Medical School, 1, Place de Verdun, F-59000, Lille, France
| | - C Collinet
- Department of School Health, Educational District of Lille, 1, Rue Claude Bernard, F-59000, Lille, France
| | - J Y Alexandre
- Psychiatry Department, Hospital of Lommelet, F-59350, Saint Andre, France
| | - Ph J Parquet
- Child and Adolescent Psychiatry Department, University Hospital, USN B, 6 Rue du Professeur Laguesse, F-59000, Lille, France
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