bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of escitalopram on sleep problems of depressive patients in real-life clinical practice in greece
Authors: Valergaki E. , Papalexi E. , Vlysidis D. , Sotiriadou K. , Giailoglou D. , Parashos I.A.
Published: May 2011

Introduction

There is a bidirectional relationship between depression and insomnia, the latter being both a risk factor for the development of depression and a consequence of depression itself. Since depressive patients with residual symptoms of insomnia are at higher risk for disease recurrence, dealing successfully with sleep disorders during antidepressive treatment is of great importance.

Objectives

The aim of the current study was to evaluate the effectiveness and tolerability of escitalopram on both depressive symptoms and sleep problems of depressive patients.

Methods

An observational, open-label, 3-month study was conducted in Greece.

Effectiveness was assessed using the CGI-S and AIS (Athens Insomnia Scale) scales. Tolerability was evaluated by spontaneously reported adverse events and treatment discontinuation rates.

Results

The study included 2,103 patients (mean age 51 ± 15 years, 64.0% women).

Patients showed significant improvement during the treatment period for both depressive symptoms and sleep problems. Mean CGI-S scores decreased from 4.2 ± 0.8 to 2.2 ± 1.0 and total AIS score decreased from 13.6 ± 4.9 to 3.5 ± 3.8 (repeated measures analysis of variance Hotelling's test, p < 0.001). The positive effect of escitalopram treatment was significant both on “night sleep” and “behaviour on the following days”. Moreover, the percentage of patients suffering from insomnia (AIS score >=6) decreased from 89.1% to 22.1% (Cochran's Q test p < 0.001). Escitalopram was also well tolerated, as 1909 (90.8%) patients successfully completed the study and 39 patients (1.85%) discontinued due to adverse events.

Conclusions

Escitalopram combines significant effectiveness on both depressive symptoms and sleep problems with good tolerability.
Polysomnographic parameters as a differentiating biological marker between severe depression and schizophrenia
Authors: Rady A. , Elsheshai A. , Elkholy O. , Abou el Wafa H.
Published: May 2011

Background and aim

Differentiation between Severe major depression and schizophrenia is oftenly a problematic issue, whether due to resemblance between negative symptoms of schizophrenia and depressive symptoms or due to presence of psychotic features with psychiatrists subjective assessment of the volume of psychotic features in relation to the whole illness. Our aim is to assess the utility of polysomnography as a differentiating tool that may add diagnostic value.

Subjects and methods

Patients were recruited randomly from the outpatient service at Alexandria University Hospital, 20 patients with severe major depression with or without psychotic features and 20 patients with schizophrenia. Diagnosis done in accordance with criteria of DSM IV-TR. Only patients scoring above 4 on the Clinical Global Impression scale for severity were recruited. Polysomnography was done to all patients while at least 1 week off medication.

Results

Depressed group showed a significantly shorter REM latency (26 ± 6.9min) and higher REM intensity (34 ± 14%) compared to schizophrenic group with REM latency (43.9 ± 16.9 min) and REM Intensity (21.4 ± 4.5). On the other hand deep sleep phases 3 and 4 constituted 12 ± 3.8% and 17.8 ± 9.2% of sleep in schizophrenic group compared to 16.4 ± 5% and 9 ± 7.9% in depressed group respectively with significant difference.

Conclusion

Polysomnography may be of benefit as a diagnostic differentiating tool between schizophrenia and severe Major depression.
Depression at patients with diabetes mellitus type II and macro vascular diseases
Authors: Rekleiti M. , Kyriazis I. , Saridi M. , Kyloudis P. , Wozniak G. , Roupa Z.
Published: May 2011

Introduction

The presence of macro vascular diseases is common among patients with diabetes mellitus, with result the increase of danger for depression appearance.The attack of greater vessels (macro vascular disease) conducts to the appearance of coronary disease, vascular brain episodes(strokes) and peripheral vasculopathy.

Aim

of this study was the examination of the relation between depression and the existence of macro vascular diseases at patients with diabetes mellitus type II.

Material-methods

164 diabetics were examined (72 male and 92 female, medieval age 66,9 ± 11,53 years), at diabetological clinics. The tools that were used at this study was the scale of depression self evaluation of Zung and a structured questionnaire about the existence of macro vascular diseases. The analysis was done with the statistic package SPSS 18.0.

Results

64,6% of diabetics reported hypertension and 61% dyslipidemia, 30,5% suffered from coronary disease and 26.2% of vascular brain episode (stroke), while 13,4% suffered from heart attack and 19,5% from other diseases. 50% of diabetics had depression at mild levels and another 20% at medium levels.

Conclusions

The majority of the sample appeared mild or medium degree depression and relation was observed between accompanying macro vascular diseases. The coronary disease, hypertension and dyslipidemia seemed to be independent prognostic factors of depression even after the abstraction of age effect and diseases duration effect, while the depressive effect of heart attack or stroke seemed to be effected mainly by age.
Examination of depression at patients with diabetes mellitus
Authors: Rekleiti M. , Wozniak G. , Saridi M. , Kyloudis P. , Toska A. , Kyriazis I. , Roupa Z.
Published: May 2011

Introduction

Depression is a dysfunction with great range of demonstrations and according to researches appears at person with diabetes mellitus two or three times more than in general population. The knowledge although about the reasons and the way that depression affects the management of diabetes are limited.

Aim

Of this study was the examination of existence of possible depression at patients with diabetes mellitus.

Material/method

164 diabetics were studied (72 male and 92 female, medieval age 66,9 ± 11,53 years) at diabetic clinics. We used the self evaluation scale of Zung (ZDRS) and structured questionnaire about demographical and body measure data.

The statistic analysis was done with the statistic package SPSS 18.0.

Results

57,3% of diabetics were overweight, and 30,5% obese, with high rates of central obesity (83,3% at males and 92,4% at females), while the big Index of Body Maze [r = 0,309, p = 0,001] and central obesity [t(162)=4,773, p = 0,001] were related significantly with depression. 50% of diabetics appeared depression symptoms at mild levels and 20% at medium levels, with the females [t(162)=3,26, p = 0,001] and elder to be related statistically significant with depression.

Conclusions

The majority of the sample appeared a level of mild or medium depression and correlation was observed between bad glycemic examinations. The daily and for many years effort of diabetes control can create the suitable situation for depressive symptomatology appearance. The examination and evaluation of the causative factors can help at the adaptation of diabetic and the solution of his problems.
Online pathways of depression
Authors: Roque Pereira M. , Pio Abreu J.
Published: May 2011

Objectives

Evaluation of concepts and reactions on a public online forum concerning depression.

Methods

Revision of 100 consecutive entries posted using an adapted Collazzi method.

Results

Comments were divided according to their content and the main subjects found were symptomatology, suicide, therapeutic advice and concerns about medication, psychotherapy and alternative therapies. The effect of a support group was found to be present based on the comments to each individual post by diminishing loneliness and deconstructing desperation. Non-therapeutic opinions were expressed and there were high levels os expressed emotion.

Conclusion

The absence of a ealth professional as group moderator may lead to conflict and misleading remarks.
Psychopathological approach in interrelation of socially disabled people
Authors: Rosentzveig E. , Cozaru C.G.
Published: May 2011

Social disability at institutionalized young people is emerging as a disadvantage compared with non-institutionalized, produced by the absence of family environment, by inadequate extra-school influences, or emotional and behavioral disorders. These disorders, subsequent to institutionalization, may lead to their transformation into other types of mental disorders, such as mental deficiency and social maladjustment.

Thus, we tried a psycho-pedagogical and psychopathological approach of depression found in individuals with social disabilities (abandoned and institutionalized children in orphanages), aiming, with specific means, a theoretical and experimental understanding of known or probable relationship between depressive symptoms and social disability for abandoned children, the practical need being to identify early manifestations of depression and begin rapidly the treatment in children abandoned.

Our conclusion was that young people in institutions are less able to regulate dysphoric-aggressive affects, compared to non-institutionalized children, which often develop conciliatory behaviors and present higher levels of tolerance.
Quantifying rater drift on the HAM-D in a sample of standardized rater training events: Implications for reliability and sample size calculations
Authors: Rothman B. , Yavorsky C. , De Fries A. , Gordon J. , Opler M.
Published: May 2011

Introduction/objectives/aims

Though rater drift in clinical trials has long been understood to negatively impact trial results, few studies have systematically quantified this. We examined training data for the HAM-D (Hamilton Depression Scale, 17-item version) at two time points to measure the impact.

Methods

Raters participating in a standardized training scored the HAM-D based on two videotaped interviews of depressed patients. To assess drift, data from an initial, post-online training session was compared to data obtained 12 months later. Intra-class correlation coefficients (Shrout & Fliess, 1979) and concordance with expert ratings were compared.

Results

Intra-class correlation coefficients (ICC) for raters (n = 167) following initial training were good to excellent for individual raters (.695–.976, p < .0001) and good for the overall cohort (.752, p < .0001). Concordance with expert ratings was excellent at 99.3%. The overall ICC fell to .730 at the second assessment and although the upper bound of individual performance remained in the good to excellent range, the frequency of scores in the poor to fair range (< .65) increased. Concordance also fell slightly to 87%.

Conclusions

Rater drift occurred over 12 months, as gauged by the metrics of reliability and concordance. Drift was apparent in a limited portion of the cohort but resulted in a lower overall ICC at the second time point. Because studies are generally powered assuming that the ICC remains stable, there are implications for both this power calculation and the required sample size.
Peripheral serotonin uptake is related to neural activation in the cingulate cortex
Authors: Scharinger C. , Kasess C. , Huf W. , Kalcher K. , Esterbauer H. , Sitte H. , Kasper S. , Moser E. , Pezawas L.
Published: May 2011

Introduction

Maximal serotonin transporter (5-HTT) densities have been found in the cingulate cortex, a cortical region that has been critically implicated in emotion processing and the pathophysiology of Major Depressive Disorder. Furthermore, serotonin (5-HT) re-uptake inhibition is the first line strategy in the treatment of depression.

Objectives

Since 5-HTTs are not restricted to neuronal cells, 5-HT uptake velocity (Vmax) can be easily measured on blood platelets subserving as peripheral model of neuronal 5-HTT function and related measures of neural activation.

Aims

To determine whether peripheral 5-HTT uptake velocity is related to neural activation in the cingulate cortex during emotion processing.

Methods

48 healthy subjects underwent an fMRI paradigm comprising emotional (angry/fearful faces and scenes) and neutral stimuli (simple shapes). 5-HT Vmax was determined in platelets. Subjects were genotyped for a common triallelic polymorphism in the promoter region of the 5-HTT gene (5-HTTLPR).

Results

Significant negative correlations between Vmax and BOLD-signal in the anterior and posterior portion of the cingulate cortex have been found. Cluster maxima within both regions were detected in the subgenual anterior cortex (−1.5, 28.5, −3.5, t = −3.77) and the ventral posterior cingulate cortex (−4.5, −49.5,14.5, t = −3.06). Genotype did not impact on this relationship.

Conclusions

Our results indicate a clear dependency between a peripheral marker, platelet 5-HT uptake velocity, and neural activity in portions of the cingulate cortex for the first time.
An experimental investigation on the perception of depression among the public
Authors: Schmoeger M. , Schosser A. , Jantscher S. , Auff E. , Willinger U.
Published: May 2011

Studies on beliefs regarding mental disorders take an interest in the question what beliefs about the causes are prevalent among the public. Studies using case vignettes concluded that lay beliefs about the causes of mental disorders clearly differ from the results of psychiatric research in view of the fact psychosocial factors are predominating in comparison with biological factors (Angermeyer & Dietrich, 2006). The aim of the present study is the evaluation of the impact of causal labels (biological/genetic, psychological/environmental or cause unknown), sex of the person described in a case vignette and sex of the participants on the perception of depression. The sample consists of 312 non-clinical participants (47.10% men, 52.90% women; mean age ± SD: 29.17 ± 12.76) who are not involved in mental health settings. To identify participants’ attitude towards depressive patients the experimental design of Lam et al. (2005) was modified and adjusted. A three way ANOVA was conducted to examine effects of causal labels, type of case vignette and sex of the participants on the attitude towards depressed patients. Simple main effects analysis only showed a significant main effect concerning sex of the participants (F = 5, 148, df = 1, p = 0,024).

The results of the current study suggest that in comparison to men, women believe that depressive patients are more affected by the symptoms of the disorder. Neither the information about the aetiology of the disorder, nor sex of the person described in the case vignette seems to have an impact on the beliefs of the participants.
The effect of cognitive remediation with a biotic designed computer based training (Mebitrain) on depressive patients: A pilot study
Authors: Christ O. , Schwarz K. , Ohlmes S. , Berger H.
Published: May 2011

Introduction

Computer based trainings (CBTs) are established in the rehabilitation of mentally ill people to recover cognitive skills (Medalia et al., 2009). The Critique to some CBTs are lack of preparation for real life scenario, no use of tasks that simultaneously engage multiple cognitive processes and lack of enhancing motivation (Medalia & Choi, 2009). This may be summarized as a lack of biotic design in CBTs.

Objective

In depressive disorders besides other symptoms a lack of energy/motivation, forgetfulness and difficulty in concentrating are observable. The goal of this pilot study was to develop a new “biotic” designed CBT (Mebitrain) and evaluate its effect on global working memory (GWM) and motivation with data from patients suffering from depression.

Methods

To test whether Mebitrain enhances GWM (measured before and after a ten day training period with the LGT from Bäumler) and motivation (measured before and after training with custom rating scales and during the training with time and performance) five depressive (ICD diagnoses F31.0, F33.2, F32.3) patients were tested.

Results

Differences between pre- (mean 33.6 ± 10.35) and post- (mean 38 ± 6) LGT values show a marginal significant trend (p = 0.1) with moderate effect size (d = .54).

The time finishing the training decreased per training session significantly with an increasing in performance (r = −.788, p < .005).

Conclusion

First results indicate that the development of a biotic designed training and its application may increase global cognitive functions and motivation in depressive patients. Limitations (e.g. sample size, transfer, etc.) of this pilot study are discussed.
BDNF and NT3 concentrations in post-mortem brain tissue of individuals with recurrent depressive disorder
Authors: Sheldrick A.J. , Camara S. , Riederer P. , Michel T.M.
Published: May 2011

Introduction

Neurotrophines such as brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT3) have been implicated in the pathogenesis of depression and the therapeutic mechanism of antidepressants. Several clinical studies on depressive disorder (DD) have shown that levels of blood BDNF are diminished in depression and increase during antidepressant treatment. So far, only few studies have examined concentrations of neurotrophic factors in post-mortem brain tissue of individuals who suffered from DD.

Objectives/aims

The objective of the study was to show whether BDNF and NT3 levels in post-mortem brain tissue of individuals who suffered from recurrent DD and who had been treated with antidepressants differed compared to controls.

Methods

Specimens from cortical and limbic areas of post-mortem brain tissue of 7 individuals with an ante-mortem diagnosis of recurrent depressive disorder based on ICD-10 criteria (F33.0–F33.8) who received no psychotropic medication other than selective serotonin re-uptake inhibitors 6 months preceding death were selected. We compared the concentrations of BDNF and NT3 with 14 matched controls without any history of psychiatric disorder or treatment with psychotropic drugs.

Results

We detected no significant differences of either NT 3 or BDNF concentrations in any of the brain regions examined in patients who had suffered from DD and had been treated with antidepressants compared to controls.

Conclusions

These findings could be interpreted as a neurotrophic effect of antidepressant treatment in patients with recurrent DD, supporting the notion that depression improvement is associated with neuroplastic changes. However, more research using post-mortem brain tissue is needed.
The period before hospitalization of patients with depressive disorders
Authors: Shmunk E.
Published: May 2011

Introduction

Depressive disorders (DD) are common and disabling. Patients with DD often have to do a long way before seeing a mental health specialist.

Objectives

To investigate characteristics of the period before hospitalization to psychiatric hospital of patients with DD.

Aims

To define clinical peculiarities of DD, investigations, treatment of depressive patients before hospitalization.

Methods

The RDC of ICD-10 and «Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version» were used.

Results

After informed agreement 102 patients with DD for the first time admitted to the psychiatric hospital were examined. The average duration of DD before psychiatric examination was 19,1 months (up to 312 months). The average number of visits to primary care (PC) was 3,6 (up to 49), the average number of investigations was 2,4 (up to 8). The most part of visits to PC felt at patients with heart complaints (р = 0,02), the less to patients with loss of energy (р = 0,0007). With the prolongation of DD the number of investigations, medications in PC and absence days increased (r > 0,2, р < 0,05). Patients with heart and gastrointestinal complaints had more investigations (р = 0,01; р = 0,03). 38,2% of patients were prescribed tranquilizers and only 23,5% antidepressants, but 54,2% of them had suboptimal dossages.

Conclusions

To summarize, in real clinical practice patients with DD still haven’t enough opportunities for early diagnostics and treatment. Systematic recognition of patient with DD, professional training of PC doctors of different specialities are cruicial.
Assessment of clinical depression comorbid to posttraumatic stress disorder
Authors: Simonović M.M. , Radisavljević M.M. , Grbeša G.B.
Published: May 2011

The aim of this investigation was to determine the group of symptoms which are the most prominent in depression comorbid to PTSD and to compare delineated features with the similar features of the depressive episode which is a part of the primary major depressive disorder (MDD).

Totally 120 patients were assessed and divided into the experimental (PTSD-depression) and control (depression-only group). The presence and the severity of the disorders were assessed by means of the following instruments: CAPS-DX, MADRS, 17-items HDRS and QIDS-SR. Statistical analysis was performed using ANOVA.

Results showed that symptoms which differed most significantly between the two groups were: sleep disturbances, trouble concentrating, poor apeetite, inner tension, agitation, fatigue and loss of energy, guilt, loss of interest and pleasure and depressed mood.

On the ground of the results obtained we reach the conclusion that depressive symptoms which were followed by PTSD are not the results of the increased activation of the neural circuits by the two pathophysiological processes, but there is the case of differential engagement of neural networks in which stimulation from the lower brain structures responsible for generation of emotional input, increasingly arrives into the upper brain structures, in which the more intense and deeper emotional processing takes place causing more intense experience of emotional stimuli and bridging the connection from perceptual and cognitive contents up to affective and visceral center of the organismus.
Implementation of a “stepped care” service for depression service limited rising antidepressant use: a population-based study
Authors: Smith M. , Morrison J. , Pelosi A.
Published: May 2011

Introduction

Like other European countries, the Defined Daily Dose (DDD) of antidepressants prescribed in Scotland increased almost fivefold in the fifteen years to 2007/8. The incidence and prevalence of depression has not changed over that period. It is not known whether this rise represents appropriate practice.

Aims

To assess the impact of stepped, collaborative care for depression on population antidepressant use.

Methods

A new depression service called “Doing Well” was implemented in 15/30 primary care practices in Renfrewshire, Scotland from July 2004 (population 76,013). Prescribing in these practices was compared with the remaining 15 “control” practices in Renfrewshire and with Scotland nationally.

Doing Well offered prompt assessment and access to guided self-help or brief CBT or IPT. Antidepressants were not recommended for patients with a PHQ score < 15, though patient preference and clinical judgement were used to guide prescribing decisions.

Results

Antidepressant use followed a “rational” profile, increasing with depression severity:

PHQ score at referral antidepressant use

0–5 0%

6–10 24%

11–15 37%

16–20 59%

21–27 70%

total 53%

Average annual DDDs of antidepressants increased by 3.8% in the Doing Well practices, 11.8% in the control practices and 12.9% in Scotland during the four years to June 08. This represents a relative reduction in DDDs in the intervention area.

Conclusions

Providing rapid, local access to brief psychological therapies and rational prescribing support was associated with a relative reduction in the rise of antidepressant use, but a modest increase in prescribing overall.
Treatment of depression, anxiety and breast cancer in slovenian female patients
Authors: Snoj Z. , Vucko I. , Licina M. , Primic Zakelj M. , Pregelj P.
Published: May 2011

Introduction

Beside psychological distress of breast cancer diagnosis and patophysiological characteristics of breast cancer it is also known that different treatments could have influence on mental well-being. The aim of this study was to investigate treatment of depression, anxiety and breast cancer in Slovenian female patients.

Results

In the study were included 314 female patients with breast cancer treated at the Institute of Oncology Ljubljana between September 2004 and July 2005. Only 18 patients were not surgically treated. Majority (80%) of all patients were treated also with chemotherapy. In combination with chemotherapy 43% of all patients received also radiotherapy and 50% received also hormonal therapy. Altogether 72 (22,9%) patients expressed clinically important serious anxiety (Hospital Anxiety and Depression (HAD) score of 11 or more on anxiety subscale), 39 (12,4%) clinically significant serious depression (HAD score of 11 or more on depression subscale) and 51 (16,2%) clinically significant depression and anxiety combined (HAD score of 11 or more on both subscales). Among patients with clinically significant serious anxiety 19 (26,4%) patients were psychiatrically treated before inclusion into study. Among patients with clinically significant serious depression 13 (33,3%) patients were psychiatrically treated before inclusion into study and among patients with clinically significant serious anxiety and depression 24 (47,0%) patients were psychiatrically treated before inclusion into study.

Conclusions

Less then half of patients with breast cancer with comorbid clinically significant expressed serious anxiety and/or depression has been psychiatrically treated before the inclusion in the study.
Mental health in the workplace
Authors: Sørensen H.Ø. , Munk-Joergensen P.
Published: May 2011

Introduction

Depression and simple phobia are the most prevalent mental illnesses among employees leading to an increased number of sick days, decreased social and professional function, job satisfaction, quality of life and increased risk of loss of work.

Around 25% of the working population is affected by psychiatric symptoms in a way that is painful to the individual, but not of such severity that is qualifies as a genuine disease.

Untreated and not early identified these cases could lead to actual mental illness.

Moreover, less than half of those currently suffering from depression are provided with the correct diagnosis in general practice, and less the half, diagnosed correctly, receive the proper medical treatment.

Objectives

To identify, treat and thereby interrupt pre-existing cases of mental illness in the workplace. To prevent worsening of minor cases of psychiatric illness and symptomatic cases not considered a genuine disease.

Aims

To develop models for early tracing and treatment of mental illness in the workplace with consequent improved health status and quality of life for the individual and improved economy for the workplace and the public.

Methods

This intervention study includes larger companies with more than 100 employees in the Region of North Denmark.

The study design is a before-after study using self-reporting questionnaires as a basis for identification of cases of mental illness and follow-up of treatment. The study uses clinical interview and examination for determining the need for treatment.

Results

Results not yet available.
QEEG cordance in the prediction of response to ketamine in depressive patients - interim analysis of randomized controlled trial
Authors: Sos P. , Klirova M. , Novak T. , Brunovsky M. , Horacek J. , Kohutova B. , Bares M. , Kopecek M. , Krajca V.
Published: May 2011

Objective

Rapid and robust antidepressant-like effect of ketamine in subanesthetic doses was already manifested in depressive patients. Maximum of mood improvement was shown within the period from 2 hours to 3 days. Previous studies proved predictive value of prefrontal QEEG theta cordance reduction after 1 week on a new antidepressant.

Congruently with previous findings we hypothesised in our compressed model decrease of QEEG cordance in 10 minutes of ketamine hydrochloride infusion as the prediction of antidepressant response.

Methods

14 MDD patients (6F/8M) diagnosed with a moderate to severe depressive episode without psychotic symptoms were included. All of the participants received the 30 minutes lasting only infusion with subanesthetic dose of ketamine hydrochloride solution (0.54 mg/kg). EEG measurements on the baseline, after 10 and 30 minutes of infusion were taken into account in computation of QEEG cordance.

Results

9 (64.3%) of subjects responded to single ketamine infusion following day and 8 (88.9%) of them decreased QEEG cordance. T-test pair comparison found significant difference between baseline and after 10 minutes of ketamine infusion in responders (F = 4.12; p < 0.003).

Conclusions

Preliminary results have shown the tendency of prefrontal QEEG cordance to decrease as a ketamine response prediction. Larger sample size is needed to increased precision in estimates of cordance sensitivity and specificity. Combination of latest QEEG method and fastest-acting antidepressant-like effect of ketamine in this trail is unexampled. Supported by IGA (MH CR) No.NS10379-3, 1M0517 (MEYS CR), MZ0PCP2005 (MH CR). Local Ethics Committee approval has been granted.
The comparative efficacy of second-generation antidepressants for the accompanying symptoms of depression: a systematic review
Authors: Thaler K. , Gartlehner G. , Hansen R.A. , Morgan L.C. , Lux L.J. , Van Noord M. , Mager U. , Gaynes B.N. , Thieda P. , Strobelberger M. , Lloyd S. , Reichenpfader U. , Lohr K.N.
Published: May 2011

Introduction

Clinicians treating patients with Major Depressive Disorder (MDD) might favor one second-generation antidepressant (SGA) because of perceived benefits for the accompanying symptoms of MDD.

Objectives

To compare the efficacy of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of the accompanying symptoms of MDD.

Methods

This review is part of a larger review on the comparative effectiveness of SGAs for MDD. We searched MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.

Results

We located 26 head-to-head and 7 placebo-controlled trials that provided evidence for this review. We did not locate any studies on treating accompanying appetite change, low energy, melancholia, or psychomotor change. There was no evidence for many comparisons and we were unable to conduct quantitative analysis for any comparisons. For the comparisons that were studied, we concluded that the SGAs are similarly efficacious for treating anxiety, insomnia, pain, and somatization. The strength of the evidence for these conclusions is low (meaning further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate).

Conclusions

Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy for the accompanying symptoms of depression.
Augmentation and combination of antidepressants with each other and with antipsychotics
Authors: Timmerman L.
Published: May 2011

Introduction

Nonrespons in first -line drug treatment of patients suffering from depression in psychiatric outpatient populations is a severe problem.

The non respons rate is up tot 30% and the non remission rate more than 50% in the first line of treatment with antidepressants in this population.

Objective

To devellop more rapid and efficious drug treatment strategies in depression.

Aims

During the last few years several strategies to improve outcome in depression have been under investigation. A few have proven to be valuable.

Methods

Medline search 2005–2010 into treatment resistent depression, combination therapy, augmentation therapy, drug therapy.

Result

There is growing evidence for the value of the combination of antidepressants and of combining antidepressants with antipsychotics.

Treatment options as pindolol addition to antidepressants, substance P or folic acid addition do not seem of clinical significance yet.

The same is true for treatment methods who directly influence the glucocorticoid system such as glucocorticoid receptor antagonists.

NMDA antagonists look promising but more research into this option is needed.

Conclusions

There are two outstanding and much promising relatively new treatment options with: Combinations of antidepressants and with combinations of an antidepressant with an antipsychotic.
Reboxetine augmentation of SSRI treatment for depression: Six-week naturalistic outcomes
Authors: Mellor R. , Loveday D. , Bell D. , Davies K. , Tranter R. ,   FoLATED Study Group (HTA Ref: 04/35/08)
Published: May 2011

Introduction

Antidepressants that combine serotonergic (SSRI) and noradrenergic (NaRI) actions may have greater efficacy in treating depression than SSRI monotherapy. This theory has not been tested in any trials examining augmentation of SSRIs with a NaRI.

Objectives

Does augmenting SSRIs with reboxetine, a NaRI, in depressed patients unresponsive to first line treatment, result in improved antidepressant efficacy?

Methods

In a naturalistic observational study, 30 patients with moderate to severe depression (ICD-10) who failed to respond to at least 20 mg of a SSRI, were augmented with reboxetine (4 mg increased to 8 mg if tolerated). BDI-II was measured before and 6 weeks after introduction of reboxetine. Changes in BDI scores were analysed using paired t-test.

Results

20 out of 30 patients were able to tolerate the combination of SSRI and reboxetine treatment for at least 6 weeks. There was a significant reduction in mean BDI-II scores from 36.6 at baseline to 27.2 at six weeks follow-up (t = 4.13, df = 29, p < 0.001). 13 out of 30 previously unresponsive patients showed a response (reduction in BDI score of at least 10 points) to combination treatment, with 5 patients achieving remission (BDI < 12) over the six weeks.

Conclusions

Reboxetine augmentation of SSRIs can be tolerated by a majority of patients and results in a significant increase in response rates. It is a treatment strategy that should be considered in patients with moderate to severe depression who fail to respond to first line treatment with an SSRI.
Impact of the number of changes of therapeutic strategy on improvement in depressed patients. dria study
Authors: Garcia-Toro M. , Valmisa E. , Galan J. , Ros S.
Published: May 2011

Introduction

The STAR*D is a pragmatic clinical trial that showed lower remission rate and higher relapse rate when more strategies were used.[1]

Objectives and aims

Assess clinical improvement in symptoms related to depression, anxiety and sleep, based on the number of strategies used.

Methods

Descriptive, non-interventional, prospective study including outpatients diagnosed with Major Depressive Disorder (MDD) with sub-optimal response to standard antidepressants. In those patients a change on the therapeutic strategy (switch of antidepressant, combination of antidepressants, augmentation or a combination of previous strategies) had to be considered necessary. Follow-up period was 22–26 weeks.

Results

364 patients were included by 58 psychiatrists, 336 were analyzed (92.3%) and 315 (86.5%) completed the follow-up.

[Difference last visit vs. basal]

p < 0.0001 in all measures

Conclusions

The more changes on strategies used the less improvement on clinical symptoms and remission rates.

This study has been sponsored by AstraZeneca Farmaceutica Spain, SA.
Parkinson's disease: Frequency of depressive syndrome
Authors: Vladejic S.D. , Vladejic S.S.
Published: May 2011

Parkinson's disease is characterized by neurological symptoms: tremor, rigor, bradykinesia and postural instability, but psychical symptoms are also present, most frequent depression and dementia.

Depression can precede neurological symptoms of disease, or be manifestation of illness itself. In literature, we find that depression major is represented in 5 – 25% of diagnosed patients, and depressive mood as isolated symptom in 40 – 60%.

Purpose of this study was to determine presence of depressive syndrome in patients diagnosed with Parkinson's disease and whether this syndrome is therapeutically sensitive. Study included all patients treated with Parkinson's disease, inmate and outpatients, during the two - year period (from 01.01.2007. up to 31.01.2009.). Hamilton's Depression Rating Scale (HAMD) was used as instrument of clinical assessment for depression, and schedule neurological examinations once a month to evaluate neurological status of patients.

Base - line scoring showed that almost 50% of patients had symptoms of depression; it was more frequent in elderly patients, treated with polytherapy. In follow - up period, we assessed patients after three and six months of antidepressive therapy. Results of statistic analysis showed improvement of psychic status of patients, according to HAMD score, in three quarters of followed patients. Exacerbation of neurological symptoms was not observed during the follow - up period.
Depression in old age
Authors: Vukovic B. , Markovic-Zigic D.
Published: May 2011

Depression in older people is related to the population over 65 years. The age of depression often go with chronic illnesses, various physical and mental diseases.

Depression in old age is not a natural part. In the elderly population 1.4% suffered from severe depression. Compared with the rest of the population prevalence of major depression is twice as large in the age group of 70–85 years. Less severe depression have an instance 4–13%. Twice as many women than men have depression. The prevalence of depression is particularly high in the elderly with dementia.

In this report we present how many old people in Serbia suffer of depression and what is new tendence in therapy.
Evaluation of a health promotion program for reducing depression, anxiety and stress in community-dwelling older adults
Authors: Walker W. , Pierce D. , Davidson S. , Walker J.
Published: May 2011

Aim

Health education programs that address risk factors for depression and promote positive mental health are approaches that can improve mental wellbeing. We investigated the effectiveness of a health promotion program for reducing levels of depression, anxiety and stress and for promoting appropriate help-seeking behaviour.

Methods

Fifty-five adults 55+years (43 female, 12 male) self-selected to attend the Healthy & Wise program - a group-based, 8 × 2hr session health-literacy program for promoting positive physical, mental and social functioning in a rural setting. A questionnaire was administered at base-line and post-intervention which included the DASS-21 to measure depression, anxiety and stress levels.

Results

No significant change in depression scores (mean = 3.60pre-3.51post). Anxiety scores increased (mean 2.92pre-3.51post) (p = .036) correlating with age (p = .029) and change in physical health status (p = .002).

Stress scores increased (mean 4.81pre-5.59post) (p = .05) correlating with age (p = .033) and change in physical health status (p = .016).

Most participants (pre = 96.36%, post = 98%) indicated they would be likely to seek help from a GP if depressed. Men who mainly rely on their spouse for support were more likely to seek help from a psychologist or psychiatrist (p = .038).

Conclusions

There was no significant change in DASS-21 scores for depression. There was an increase in anxiety and stress levels which may be attributable to older participants experiencing a decline in physical health during the program. Participants remained firm in their preference for seeking help from their GP for depression. Further evaluation is needed to determine whether: at-risk-populations need to be targeted; the intervention has an impact at 12-month follow-up.
Effects of positive and negative affect and emotional supression on short-term life satisfaction and depression: Considering activation of affect
Authors: Yamasaki K. , Sasaki M. , Uchida K. , Katsuma L.
Published: May 2011

Objectives

We examined the effects of affect and emotional suppression (ES) on short-term life satisfaction (LS) and depression. In doing so, we considered the dimension of activation for positive affect (PA) and negative affect (NA).

Methods

The final sample included the data collected from 496 undergraduate and graduate students (240 men and 256 women). Participants answered seven questionnaires for assessing activated PA and NA, ES of PA and NA, short-term LS, and depression, three of which were used for another study. All of them were Japanese versions, answered on the past week.

Results

Results from hierarchical regression analyses showed that LS was positively associated with PA and negatively with NA, but that its positive association was stronger in activated PA than deactivated PA while its negative association was stronger in deactivated NA than activated NA. Similar findings were obtained for depression. The significant interactions suggested:

(1)

higher scores of ES of PA weaken the positive association between activated PA and LS in both sexes;

(2)

higher scores of ES of NA strengthen the negative association between activated NA and LS in men and weaken the association in women; and

(3)

the positive association between activated NA and depression is weakened by higher scores of ES of NA in women.

Conclusion

This study suggested that activated and deactivated affect differ in their relations to life satisfaction and depression. Moreover, it is likely that although ES of PA and NA influences health, its effects would be different between men and women.
Depression among final year medical students in universiti sains malaysia (USM): associated, risk and determinant factors
Authors: Yusoff M.S.B. , Abdul Rahim A.F. , Yaacob M.J.
Published: May 2011

Objective

This study interested in gathering data on the prevalence of depression and its contributing factors among final year medical students in USM.

Methods

A cross-sectional study was done. A total of 187 final year medical students of the 2007/2008 batch were selected as in study subjects. The Malay Beck's Depression Inventory (M-BDI_ was administered to identify depressed students. Data were collected during housemanship course, one week after their final summative examination.

Result

A total of 92 (49.2%) students responded to this survey. The percentage of depression among the students was 21.7%: approximately 19.5% with mild depression and 2.2% with moderate depression respectively. The mean M-BDI scores were found to be significantly increased among female medical students (p < 0.05), those in difficulties with peer and love relationships (p < 0.01), and those with poor general health status (p < 0.001). Logistic regression showed female students, those in difficulties with love relationship and those with poor general health were at higher risk to develop depression (X2 (df) = 26.59 (3), p < 0.001). Multi-factorial ANOVA analysis showed that two factors contribute to depression among final year medical students which were gender and general health status (F (df) = 5.934 (13), p < 0.001).

Conclusion

The prevalence of depression among medical student was high. Female medical students, those in difficulties with love relationship, and poor general health status were at high risk to develop depression. Gender and general health status were determinant factors of depression among USM final year medical students.
Volition inhibitory to emotional stimuli in depression: Evidence from the antisaccade tasks
Authors: Luo X. , Chen R. , Guo W. , Zhang H. , Zhou R.
Published: May 2011

Introduction

Most previous researches indicated that impaired inhibition to emotional stimuli could be one of the important cognitive characteristics of depression individuals. The antisaccade tasks which composed of prosaccade task (PS) and antisaccade task (AS) were often used to investigate response inhibition.

Aims

This study aimed to investigate the volition inhibition toward emotional stimuli in depressed mood undergraduates (DM).

Methods

Subjects were grouped as 21 DM and 25 non-depressed undergraduates (ND) on the Beck Depression Inventory and Self-rating Depression Scale. The antisaccade tasks were conducted to examine the inhibition abilities by varying the arousal level of volition (low and high) of the tasks, with happy, neutral and sad facial expressions as stimuli.

Results

The results showed that at the low volition level in the AS condition, the correct saccade latency in the DM were significant slower than the ND; The DM had reliable higher direction error rates in response to emotional facial expressions, especially for sad expressions. However, all of the differences disappeared in the high volition level antisaccade tasks. The amplitude errors data were not influenced by emotional facial expressions, and there were no group differences across tasks.

Conclusions

These results indicated the DM showed slower speed of cognitive processing and impaired inhibition abilities toward emotional faces than the ND, particularly for sad faces, but these abilities will be repaired in the high arousal level of volition, which enlighten us that training the DM's volition level of inhibition could prove to be an effective strategy to alleviate depression.
Therapeutic resistance of antidepressants
Authors: Zoric D. , Miskovic M. , Zivlak-Radulovic N. , Maglov T. , Ilic D.
Published: May 2011

Depression is not a transient feeling of resentment, it is a disease that significantly impairs daily life. It is result of the imbalance of chemical substances in the brain, with an important role of heritage, stress and lifestyle.

This paper presents a case of a patient who has had two hospital treatment in a span of 25 years, and who was treated with antidepressants both older and the newer generation, without therapeutic response. Therapeutic response was achieved with application of ECT after the first hospitalization in 1987 and remission lasted for 25 years without treatment. After 25 years, when the disease re-emerged, and the number of antidepressants on the market has increased, patient’s recovery was again absent, even she was treated with newer antidepressant. Residual symptoms are very severe, and are essential for social and professional functions.

Today, despite a number of antidepressant available, 30–50% of all patients still do not have satisfactory response to initial treatment.
Eating disorders and intrasexual competition: Testing an evolutionary hypothesis among young women
Authors: Mehta S. , Abed R. , Figueredo A.J. , Aldridge S. , Balson H. , Meyer C. , Palmer R.
Published: May 2011

Introduction

Competing theories on the aetiology of eating disorders originate from a diverse set of disciplines. One such discipline is Evolutionary Psychology which assumes that the human mind has been shaped by natural and sexual selection. Most evolutionary theories on eating disorders limit themselves to the causation of anorexia nervosa only. The Sexual Competition Hypothesis (SCH), based on the Darwinian theory of sexual selection, provides an explanatory framework for the whole spectrum of eating disorders. It contends that intense female intrasexual competition (ISC) is the ultimate cause of eating disorders. The SCH explains the phenomenon of the pursuit of thinness as an adaptation to ISC in the modern environment. It argues that eating disorders are pathological phenomena that arise from the mismatch between the modern environment and the inherited female adaptations for ISC.

Objectives

To test predictions from a novel evolutionary hypothesis for eating disorders.

Aims

i)

To examine the relationship between disordered eating behaviour (DEB) and ISC in a sample of female undergraduates.

ii)

To establish whether there is any relationship between DEB and Life History (LH) strategy.

Methods

A group of 206 female undergraduates were recruited. A structural equation model was constructed to analyse the data.

Results

ISC for mates was significantly associated with DEB, as predicted by the SCH. DEB was found to be predicted by fast LH strategy, which was only partially mediated by the SCH.

Conclusions

The results of this study are supportive of the SCH and justify research on a clinical sample.