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Vega-Zelaya L, Pastor J. The Network Systems Underlying Emotions: The Rational Foundation of Deep Brain Stimulation Psychosurgery. Brain Sci 2023; 13:943. [PMID: 37371421 DOI: 10.3390/brainsci13060943] [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: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Science and philosophy have tried to understand the origin of emotions for centuries. However, only in the last 150 years have we started to try to understand them in a neuroscientific scope. Emotions include physiological changes involving different systems, such as the endocrine or the musculoskeletal, but they also cause a conscious experience of those changes that are embedded in memory. In addition to the cortico-striato-thalamo-cortical circuit, which is the most important of the basal ganglia, the limbic system and prefrontal circuit are primarily involved in the process of emotion perceptions, thoughts, and memories. The purpose of this review is to describe the anatomy and physiology of the different brain structures involved in circuits that underlie emotions and behaviour, underlying the symptoms of certain psychiatric pathologies. These circuits are targeted during deep brain stimulation (DBS) and knowledge of them is mandatory to understand the clinical-physiological implications for the treatment. We summarize the main outcomes of DBS treatment in several psychiatric illness such as obsessive compulsive disorder, refractory depression, erethism and other conditions, aiming to understand the rationale for selecting these neural systems as targets for DBS.
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Affiliation(s)
- Lorena Vega-Zelaya
- Clinical Neurophysiology, Instituto de Investigación Biomédica Hospital, Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain
| | - Jesús Pastor
- Clinical Neurophysiology, Instituto de Investigación Biomédica Hospital, Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain
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2
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Nagi T, Jagtiani A, Somvanshi S, Seegobin SA, Singh J, Bachu AK, Pathak M. Ketamine Augmentation of Electroconvulsive Therapy: A Scoping Review of Dose-Dependent Effects in Major Depressive Disorder. Cureus 2023; 15:e40087. [PMID: 37292107 PMCID: PMC10246511 DOI: 10.7759/cureus.40087] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/10/2023] Open
Abstract
Intravenous ketamine infusions in subanesthetic doses have been shown to rapidly alleviate depressive symptoms. However, the efficacy of ketamine as an anesthetic during electroconvulsive therapy (ECT) for major depression has not yet been answered by a large randomized control trial (RCT). This scoping review aims to examine the available literature to determine whether the dose of ketamine used during ECT influences the response to treatment. A literature search was conducted on PubMed to identify all published RCTs within the last 10 years which compared ketamine anesthesia during ECT for major depression with another anesthetic. Studies using low (<0.8 mg/kg) versus high (≥0.8 mg/kg) doses of ketamine during ECT were evaluated for the differences in outcomes using depression rating scales. Studies that examined ketamine as a standalone treatment for depression or focused primarily on the anesthetic benefits of ketamine were excluded from our review. Fifteen studies were utilized for this literature review. Overall, the studies showed inconsistent results in terms of the speed and magnitude of response to ketamine-assisted ECT in patients with major depression. Limitations of the available literature are discussed, including the lack of head-to-head comparisons, differences in methodology, inclusion/exclusion criteria, and primary and secondary endpoints.
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Affiliation(s)
- Tarika Nagi
- Psychiatry, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Amit Jagtiani
- Psychiatry, Burrell Behavioral Health, Springfield, USA
| | - Saurabh Somvanshi
- Psychiatry and Behavioral Sciences, Northwell Health - Zucker Hillside Hospital, New York, USA
| | | | - Jasbir Singh
- Psychiatry, University of California, Los Angeles - Kern Medical Center, Bakersfield, USA
| | - Anil K Bachu
- Psychiatry and Behavioral Sciences, Baptist Health-UAMS (University of Arkansas for Medical Sciences), Little Rock, USA
- Psychiatry and Behavioral Sciences, Allegheny Health Network, Pittsburgh, USA
| | - Meenal Pathak
- Psychiatry, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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3
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Moeller SB, Gbyl K, Hjorthøj C, Andreasen M, Austin SF, Buchholtz PE, Fønss L, Hjerrild S, Hogervorst L, Jørgensen MB, Ladegaard N, Martiny K, Meile J, Packness A, Sigaard KR, Straarup K, Straszek SPV, Soerensen CH, Welcher B, Videbech P. Treatment of difficult-to-treat depression - clinical guideline for selected interventions. Nord J Psychiatry 2022; 76:177-188. [PMID: 34455900 DOI: 10.1080/08039488.2021.1952303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/20/2022]
Abstract
BACKGROUND Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark. METHODS Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences. RESULTS We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD. CONCLUSION The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines.
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Affiliation(s)
- Stine Bjerrum Moeller
- Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Krzysztof Gbyl
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - Core, Mental Health Center Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maike Andreasen
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Department of Psychology, University of Southern Denmark, Slagelse, Denmark
| | - Poul Erik Buchholtz
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Line Fønss
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
| | - Simon Hjerrild
- Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Martin Balslev Jørgensen
- Mental Health Center Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Ladegaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jonas Meile
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Aake Packness
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The Royal Danish Library, Aarhus University Library, Health Sciences, Aarhus, Denmark
| | | | - Krista Straarup
- Research and Treatment Program for Bipolar Disorder, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Birgitte Welcher
- Mental health Center Psychiatry Vest, Region Zealand Psychiatry, Slagelse, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research (CNDR), Psychiatric Center Glostrup, Capital Region Psychiatry, Glostrup, Denmark
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4
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Liu P, Zhang SS, Liang Y, Gao ZJ, Gao W, Dong BH. Efficacy and Safety of Esketamine Combined with Antidepressants for Treatment-Resistant Depression: A Meta-Analysis. Neuropsychiatr Dis Treat 2022; 18:2855-2865. [PMID: 36514492 PMCID: PMC9741854 DOI: 10.2147/ndt.s388764] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of esketamine + antidepressant in treatment-resistant depression. METHODS We searched PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain published information on esketamine + antidepressant from inception to July 2022. We searched for randomized controlled studies on the treatment of depression with a double-blind induction phase. Outcome indicators included changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores before and after treatment, effective response rate, remission rate, and changes in self-rating depression scale (SDS). We analyzed data using Review Manager 5.4 and assessed the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis. RESULTS A total of seven articles were included, including 701 patients in the esketamine + antidepressant group and 551 in the placebo group. Meta-analysis results showed that esketamine + antidepressant could improve the MADRS score in patients with treatment-resistant depression (MD = -2.68, 95% CI -3.98 to -1.37, P < 0.0001), SDS (MD = -2.9, 95% CI -4.01 to -1.79, P < 0.00001), response rate at the end of the double-blind induction period (RR = 1.28, 95% CI 1.12 to 1.46, P = 0.0002), remission rate at the end of the double-blind induction period (RR = 1.39, 95% CI 1.18 to 1.63, P < 0.0001), Five-Dimensional Health Scale (EQ-5D-5L) (MD = 0.05, 95% CI 0.02 to 0.08, P = 0.00009), Visual Analogue Scale of Health Status (EQ-VAS) (MD = 5.54, 95% CI 2.37 to 8.71, P = 0.0006). CONCLUSION Esketamine + antidepressant has an obvious curative effect in treatment-resistant depression and can rapidly improve depression in patients, quality of life and satisfaction, but minor adverse reactions can occur.
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Affiliation(s)
- Peng Liu
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Shan-Shan Zhang
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Yun Liang
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Medical University, Xi'an, People's Republic of China
| | - Zi-Jun Gao
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Bu-Huai Dong
- Department of Anesthesiology, Xi'an Honghui Hospital, Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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5
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Jiang X, Xie Q, Liu LZ, Zhong BL, Si L, Fan F. Efficacy and safety of modified electroconvulsive therapy for the refractory depression in older patients. Asia Pac Psychiatry 2020; 12:e12411. [PMID: 32783403 DOI: 10.1111/appy.12411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 12/26/2019] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We explored the clinical efficacy and safety of modified electroconvulsive therapy (ECT) in the treatment of elderly patients with refractory depression. METHODS A total of 43 older patients with refractory depression were enrolled in our study from March 2014 to February 2015, with the average age of 65 ± 4.8 years old. Modified electroconvulsive therapy (ECT) was performed in these patients after physical examinations and anesthesia procedures. Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to assessing the efficacy of ECT, and Wechsler Memory Scale (WMS) and mini-mental state examination (MMSE) were used to evaluate the memory ability and cognitive function. RESULTS The rate of efficacy was calculated as 67.44% after 4 weeks of ECT treatment. Our results showed that HAMA and HAMD scores after 2 weeks of ECT treatment were significantly lower than pretreatment, and the differences were more significant after 4 weeks of ECT treatment. Compared with pretreatment, the scores of memory quotient and immediate memory of WMS decreased significantly after 1 week of treatment. However, these events were not be presented with the progress of treatment, except for after 2 weeks of treatment. Our results demonstrated that compared with pretreatment, the scores of MMSE significantly increased after 4 weeks of treatment. CONCLUSION ECT is an effective, well-tolerated, and safe method for the treatment of older patients with refractory depression. ECT can be recommended for the treatment of these patients after conducting effective risk control of comorbid somatic diseases.
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Affiliation(s)
- Xue Jiang
- Psychiatric Intensive Care Unit (PICU), Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Qin Xie
- Psychiatric Intensive Care Unit (PICU), Wuhan Mental Health Center, Wuhan, Hubei, China
| | | | | | - Liang Si
- Psychiatric Intensive Care Unit (PICU), Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Fang Fan
- Psychiatric Intensive Care Unit (PICU), Wuhan Mental Health Center, Wuhan, Hubei, China
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6
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Little JN, Codd RT. Radically Open Dialectical Behavior Therapy (RO DBT) in the treatment of perfectionism: A case study. J Clin Psychol 2020; 76:2097-2108. [PMID: 32976641 DOI: 10.1002/jclp.23062] [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: 06/05/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/08/2022]
Abstract
We present the case of an adult male ("Jake") with chronic Anorexia Nervosa, buttressed by dysfunctional levels of perfectionism and aggravated by long-standing mood and anxiety disturbance, successfully treated with Radically Open Dialectical Behavior Therapy (RO DBT). RO DBT is an evidence-based, transdiagnostic psychotherapy designed to address perfectionistic overcontrolled coping through teaching flexibility, openness, and healthy self-doubt. We illustrate this treatment approach by means of describing its application to this case, including discussing core RO DBT treatment strategies and providing sample dialogues. Also demonstrated are the importance of case conceptualization strategies specific to overcontrolled individuals, unique challenges with attending to alliance ruptures with this population such as difficulty discriminating when they occur, and the importance of prioritizing social signaling as a treatment target. Jake's Anorexia Nervosa was in remission at the conclusion of treatment.
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Affiliation(s)
| | - R Trent Codd
- Cognitive-Behavioral Therapy Center of Western North Carolina, Ashville, North Carolina, USA
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7
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Wang M, Xiong Z, Su B, Wang L, Li Z, Yang Y, Fang J, Li Z. Repeated ketamine injections in synergy with antidepressants for treating refractory depression: A case showing 6-month improvement. J Clin Pharm Ther 2020; 45:199-203. [PMID: 31468568 DOI: 10.1111/jcpt.13041] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Some patients with refractory depression who fail to respond to rapid injection of standard-dose ketamine are injected with high doses, but the safety and efficacy of this practice are unclear. CASE DESCRIPTION A 57-year-old woman with refractory depression whose symptoms did not improve after 20-seconds intravenous injection of 0.5 mg/kg ketamine went into remission following eight, 1-minute intravenous injections of 1 mg/kg ketamine delivered over a 4-week period. By 6-month follow-up, no significant adverse events had occurred and cognitive function had improved. WHAT IS NEW AND CONCLUSION High-dose intravenous injections of ketamine may stably improve depressive symptoms and cognitive function in patients with refractory depression who do not respond to rapid intravenous injection of standard-dose ketamine. The high-dose treatment appears to be associated with only mild side effects.
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Affiliation(s)
- Min Wang
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Bin Su
- The Second Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Lan Wang
- The Second Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Yali Yang
- The Second Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Jing Fang
- The Second Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Zhe Li
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- The Mental Rehabilitation Center, Karamay Municipal People's Hospital, Karamay, China
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8
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Lent JK, Arredondo A, Pugh MA, Austin PN. Ketamine and Treatment-Resistant Depression. AANA J 2019; 87:411-419. [PMID: 31612847] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Major depressive disorder affects tens of millions of people each year. One-third of those affected have depression that is resistant to conventional pharmacologic, psychologic, or somatic treatments. Patients with treatment-resistant depression have few remedies other than electroconvulsive therapy or transcranial magnetic stimulation. Recent research has highlighted the promising antidepressant effects of subanesthetic ketamine infusions. This journal course examines the efficacy of ketamine for treatment-resistant depression. Evidence from 10 systematic reviews and randomized controlled trials suggest that most of the researchers concluded ketamine significantly decreased depression severity ratings at short-term assessment intervals, whereas evidence examining the long-term effects is lacking. Ketamine infusion therapy was generally well tolerated, with minimal untoward effects. Large, randomized controlled trials are needed to discern the longer-term efficacy, tolerance, and dependence profiles of ketamine infusions. Optimal dosing schedules to best prolong the antidepressant effects of ketamine have yet to be determined.
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Affiliation(s)
- Jennifer K Lent
- is the chief nurse anesthetist at Yukon Kuskokwim Delta Regional Hospital in Bethel, Alaska. The author was a student in the Doctor of Nurse Anesthesia Practice program at Texas Wesleyan University in Fort Worth, Texas, at the time this article was written
| | - Albert Arredondo
- is the chief nurse anesthetist at Southwestern Medical Center in Lawton, Oklahoma. He is also a co-owner of the Red River Ketamine Wellness Center in Lawton, Oklahoma. The author was a student in the Doctor of Nurse Anesthesia Practice program at Texas Wesleyan University at the time this article was written
| | - Marilyn A Pugh
- is an associate professor of psychology at Texas Wesleyan University
| | - Paul N Austin
- is a professor and the coordinator of the Research and Anesthesia Curriculum for the Doctor of Nurse Anesthesia Practice program at Texas Wesleyan University
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9
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Ghosh P, Viswanath O. Promoting the Discussion of the Beneficial Effects of Ketamine to Treat Refractory Depression. Psychopharmacol Bull 2019; 49:98-99. [PMID: 30858644 PMCID: PMC6386424] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Priyanka Ghosh
- Ghosh, MD, Harvard Medical School, Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Viswanath, MD, Valley Anesthesiology and Pain Consultants, Phoenix, Arizona; Creighton University School of Medicine, Omaha, Nebraska; University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Omar Viswanath
- Ghosh, MD, Harvard Medical School, Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Viswanath, MD, Valley Anesthesiology and Pain Consultants, Phoenix, Arizona; Creighton University School of Medicine, Omaha, Nebraska; University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
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10
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Zhao X, Li Y, Tian Q, Zhu B, Zhao Z. Repetitive transcranial magnetic stimulation increases serum brain-derived neurotrophic factor and decreases interleukin-1β and tumor necrosis factor-α in elderly patients with refractory depression. J Int Med Res 2019; 47:1848-1855. [PMID: 30616482 PMCID: PMC6567781 DOI: 10.1177/0300060518817417] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on serum levels of brain-derived neurotrophic factor (BDNF), interleukin (IL)-1β, and tumor necrosis factor (TNF)-α in elderly patients with refractory depression. Methods A total of 58 elderly patients diagnosed with refractory depression between January 2015 and December 2016 were divided randomly into two groups: 29 patients who received rTMS and 29 controls without rTMS. Thirty healthy individuals were also enrolled and all received rTMS. Serum levels of BDNF, IL-1β, and TNF-α were measured before the study (0 days), and at 48 hours and 1, 2, 3, and 4 weeks after the first TMS treatment. Results BDNF levels gradually increased with treatment duration in the rTMS group and were significantly higher compared with the control group. In contrast, IL-1β and TNF-α levels gradually decreased and were significantly lower than in the control group. None of the serum factors were affected by rTMS in the healthy individuals. BDNF levels were negatively correlated and IL-1β and TNF-α levels were positively correlated with Hamilton Depression Rating Scale-24 scores. Conclusion These results suggest that rTMS may increase BDNF and decrease IL-1β and TNF-α serum levels in elderly patients with refractory depression.
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Affiliation(s)
- Xiangxiang Zhao
- 1 Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China.,2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanpeng Li
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Tian
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bingqian Zhu
- 3 School of Nursing, Shanghai Jiaotong University, Shanghai, China
| | - Zhongxin Zhao
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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11
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Zhang A, Li G, Yang C, Liu P, Wang Y, Kang L, Wang Y, Zhang K. Alterations of amplitude of low-frequency fluctuation in treatment-resistant versus non-treatment-resistant depression patients. Neuropsychiatr Dis Treat 2019; 15:2119-2128. [PMID: 31413577 PMCID: PMC6663073 DOI: 10.2147/ndt.s199456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We used parcellation based on 264 putative functional areas to explore the difference of amplitude of low-frequency fluctuation (ALFF) between refractory depression and non-refractory depression patients. PATIENTS AND METHODS Sixty first episode drug-naive patients with major depressive disorder (MDD) and 20 healthy controls (HCs) were recruited in this study; the MDD group was divided into a refractory depression (TRD) group (n=15) and a non-refractory depression (non-TRD) group (n=18) according to the treatment effect following up for 2 years. All the subjects underwent magnetic resonance imaging scanning and performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and all the patients with MDD finished the 17-item Hamilton Depression Rating Scale (HAMD17). We used a parcellation based on 264 putative functional areas to explore the difference of ALFF measures in the three groups. The correlation between the abnormal ALFF value and characteristics of MDD was examined. RESULTS RBANS total scores and index scores in the HCs were significantly different from that of the MDD group. HAMD-17 in the TRD group was significantly higher than that of non-TRD group. Relative to HCs, MDD groups showed significantly lower ALFF within the right default mode network, which was positively correlated with the immediate memory and language in the MDD group. Compared with the non-TRD group, the TRD group showed higher ALFF in the right sensory/somatomotor hand, right auditory and left default mode network. CONCLUSION Dysfunction of the somatosensory areas, right auditory and left default mode network may be a marker for specific psychopathology symptoms of TRD.
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Affiliation(s)
- Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China.,Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Penghong Liu
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Lijun Kang
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Yuchen Wang
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
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12
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Winter J, Falkai P, Schüle C. [The crying patient]. MMW Fortschr Med 2018; 160:50-53. [PMID: 30206847 DOI: 10.1007/s15006-018-0887-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jana Winter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Univ. München, LMU München, Nussbaumstraße 7, D-80336, München, Deutschland.
| | - Peter Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Univ. München, LMU München, Nussbaumstraße 7, D-80336, München, Deutschland
| | - Cornelius Schüle
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Univ. München, LMU München, Nussbaumstraße 7, D-80336, München, Deutschland
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Mędrala T, Pycińska A, Pyciński B, Merk W, Kucia K. Electroconvulsive therapy in 77-year-old patient with pacemaker: a case report. Neuropsychiatr Dis Treat 2018; 14:1055-1058. [PMID: 29713175 PMCID: PMC5909799 DOI: 10.2147/ndt.s162125] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of a 77-year-old patient suffering from severe psychotic depression with a cardiac pacemaker is described. Because of treatment-resistant depression, electroconvulsive therapy (ECT) was introduced. In the course of ECT, there was a great improvement in his mental state without any cardiac complications. This case may be evidence for the safety and effectiveness of ECT in the elderly, even with cardiac comorbidities. Some recommendations for ECT in patients with pacemakers are discussed.
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Affiliation(s)
- Tomasz Mędrala
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice
| | - Anna Pycińska
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice
| | - Bartłomiej Pyciński
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Wojciech Merk
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice
| | - Krzysztof Kucia
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice
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Valiengo L, Benseñor IM, Goulart AC, de Oliveira JF, Zanao TA, Boggio PS, Lotufo PA, Fregni F, Brunoni AR. The sertraline versus electrical current therapy for treating depression clinical study (select-TDCS): results of the crossover and follow-up phases. Depress Anxiety 2013; 30:646-53. [PMID: 23625554 DOI: 10.1002/da.22079] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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] [Received: 08/14/2012] [Revised: 11/21/2012] [Accepted: 01/18/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising nonpharmacological therapy for major depression. In the Sertraline versus Electrical Current Therapy for Treating Depression Clinical Trial (SELECT-TDCS) trial, phase-I (Brunoni et al., JAMA Psychiatry, 2013) we found that tDCS is effective for the acute episode. Here, we describe tDCS effects during phases II (crossover) and III (follow-up) of this trial (NCTs: 01149889 and 01149213). METHODS Phase II (n = 25) was the open-label, crossover phase in which phase-I nonresponders who had received sham-tDCS received a 10-day course of active-tDCS. In phase-III (n = 42), all active-tDCS responders (>50% Montgomery-Asberg Depression Rating Scale (MADRS) improvement or MADRS ≤ 12) were enrolled to a 24-week, follow-up phase in which a maximum of nine tDCS sessions were performed-every other week for 3 months and, thereafter, once a month for the subsequent 3 months-sessions would be interrupted earlier whether the subject relapsed. TDCS was applied at 2 mA/30 min, with the anode over the left and the cathode over the right dorsolateral prefrontal cortex. Relapse was the outcome measure. RESULTS In phase-II, 52% of completers responded to tDCS. In phase-III, the mean response duration was 11.7 weeks. The survival rate per Kaplan-Meier analysis was 47%. Patients with treatment-resistant depression presented a much lower 24-week survival rate as compared to nonrefractory patients (10% vs. 77%, OR = 5.52; P < .01). Antidepressant use (sertraline 50 mg/day, eight patients) was not a predictor of relapse. TDCS was well tolerated and with few side effects. CONCLUSION Continuation tDCS protocols should be optimized as to prevent relapse among tDCS responders, particularly for patients with baseline treatment-resistant depression.
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Affiliation(s)
- Leandro Valiengo
- Clinical Research Center, University Hospital, University of São Paulo, São Paulo, Brazil
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Hoogenboom WS, Perlis RH, Smoller JW, Zeng-Treitler Q, Gainer VS, Murphy SN, Churchill SE, Kohane IS, Shenton ME, Iosifescu DV. Feasibility of studying brain morphology in major depressive disorder with structural magnetic resonance imaging and clinical data from the electronic medical record: a pilot study. Psychiatry Res 2013; 211:202-13. [PMID: 23149041 PMCID: PMC3574623 DOI: 10.1016/j.pscychresns.2012.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Received: 08/16/2011] [Revised: 06/13/2012] [Accepted: 07/11/2012] [Indexed: 01/17/2023]
Abstract
For certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six non-remitters), and 15 healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied.
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Affiliation(s)
- Wouter S. Hoogenboom
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, United States,Corresponding author: Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, 1249 Boylston Street, Boston, MA 02215, United States, Tel: +1 617 455 8929, Fax: +1 617 525 6150,
| | - Roy H. Perlis
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States,Center for Human Genetic Research, Laboratory of Psychiatric Pharmacogenomics, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Jordan W. Smoller
- Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Qing Zeng-Treitler
- University of Utah, Department of Biomedical Informatics, Salt Lake City, UT 84112, United States,VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, United States
| | - Vivian S. Gainer
- Information Systems, Partners HealthCare System, Inc., Charlestown, MA 02129, United States
| | - Shawn N. Murphy
- Information Systems, Partners HealthCare System, Inc., Charlestown, MA 02129, United States,Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Susanne E. Churchill
- i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Isaac S. Kohane
- i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, United States,Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Brockton Division, Brockton, MA 02301 and Harvard Medical School, Boston, MA 02115, United States
| | - Dan V. Iosifescu
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States,Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY 10029, United States
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Tominaga K, Okazaki M, Higuchi H, Utagawa I, Nakamura E, Yamaguchi N. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression. Int J Gen Med 2011; 4:515-9. [PMID: 21845058 PMCID: PMC3150173 DOI: 10.2147/ijgm.s21029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression. METHODS This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores. RESULTS The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders. CONCLUSION This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression.
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Affiliation(s)
- Keiichiro Tominaga
- Department of Neuropsychiatry, St Marianna University School of Medicine, Miyamae-ku, Kawasaki City, Kanagawa
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