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European Neuropsychopharmacology : the... Oct 2015The depressive state has been characterised as one of elevated inflammation, which holds promise for better understanding treatment-resistance in affective disorders as... (Meta-Analysis)
Meta-Analysis Review
The depressive state has been characterised as one of elevated inflammation, which holds promise for better understanding treatment-resistance in affective disorders as well as for future developments in treatment stratification. Aiming to investigate alterations in the inflammatory profiles of individuals with depression as putative biomarkers for clinical response, we conducted meta-analyses examining data from 35 studies that investigated inflammation before and after treatment in depressed patients together with a measure of clinical response. There were sufficient data to analyse IL-6, TNFα and CRP. Levels of IL-6 decreased with antidepressant treatment regardless of outcome, whereas persistently elevated TNFα was associated with prospectively determined treatment resistance. Treatment non-responders tended to have higher baseline inflammation, using a composite measure of inflammatory markers. Our findings suggest that elevated levels of inflammation are contributory to treatment resistance. Combining inflammatory biomarkers might prove a useful tool to improve diagnosis and detection of treatment refractoriness, and targeting persistent inflammation in treatment-resistant depression may offer a potential target for the development of novel intervention strategies.
Topics: Biomarkers; Depressive Disorder; Humans
PubMed: 26169573
DOI: 10.1016/j.euroneuro.2015.06.007 -
Biomarkers in Medicine 2015Major depressive disorder is a heterogeneous disorder, mostly diagnosed on the basis of symptomatic criteria alone. It would be of great help when specific biomarkers... (Review)
Review
Major depressive disorder is a heterogeneous disorder, mostly diagnosed on the basis of symptomatic criteria alone. It would be of great help when specific biomarkers for various subtypes and symptom clusters of depression become available to assist in diagnosis and subtyping of depression, and to enable monitoring and prognosis of treatment response. However, currently known biomarkers do not reach sufficient sensitivity and specificity, and often the relation to underlying pathophysiology is unclear. In this review, we evaluate various biomarker approaches in terms of scientific merit and clinical applicability. Finally, we discuss how combined biomarker approaches in both preclinical and clinical studies can help to make the connection between the clinical manifestations of depression and the underlying pathophysiology.
Topics: Animals; Biomarkers; Depressive Disorder, Major; Humans
PubMed: 25731213
DOI: 10.2217/bmm.14.114 -
Journal of Affective Disorders Jan 2017The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure... (Review)
Review
BACKGROUND
The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives.
METHODS
All studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtained and are considered in this review.
RESULTS
Findings suggest high reliability in quantifying CORE scores can be achieved and that it has construct validity as a measure of PMD. A number of application studies assessing socio-demographic factors, cognitive and motor impairment, dexamethasone suppression and thyrotropin-releasing hormone, response to psychotherapy and to electroconvulsive therapy support its validity as a measure of melancholia, while functional brain imaging studies suggest that the measure identifies regions of decreased connectivity.
LIMITATIONS
Use of the CORE benefits from rater training and for subjects to be assessed at or near nadir of their depressive episode. There have been insufficient studies evaluating genetic factors, and the treatment response of CORE-defined melancholic patients to antidepressant drugs of differing classes.
CONCLUSIONS
The CORE, either as a proxy or direct measure of melancholia, provides a strategy for assigning depressed subjects a diagnosis or melancholic or non-melancholic depression or for estimating the probability of melancholia.
Topics: Antidepressive Agents; Brain; Depressive Disorder; Electroconvulsive Therapy; Humans; Psychiatric Status Rating Scales; Psychomotor Disorders; Psychotherapy; Reproducibility of Results
PubMed: 27721186
DOI: 10.1016/j.jad.2016.09.029 -
L'Encephale Feb 2016In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the... (Review)
Review
In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the worsening, the lack of response, partial response and poor tolerance. This lack of response may be related to intrinsic factors to the individual, but also to more extrinsic environmental factors. In this review, we explore this concept through its links with adherence and treatment duration. In this field, the concept of early response can be a powerful indicator of therapeutic response, which conditions the prescription of antidepressants beyond the strict framework of the sufficient period of 4 to 6 weeks. In addition to its impact on prognosis, the literature data show that the insufficient response is a significant burden in terms of medical and economic cost, and somatic comorbidity; and justifies a systematic identification of this dimension. Therefore self-reports (QIDS; BDI) will be preferred to the clinician-rated depression symptom rating scales (MADRS, HAMD) that require a specific training. Identifying predictors of non-response would be an attractive target for prescribers but the results to date are not operative.
Topics: Antidepressive Agents; Depressive Disorder; Depressive Disorder, Major; Humans; Psychiatric Status Rating Scales; Self Report; Treatment Failure
PubMed: 26879255
DOI: 10.1016/S0013-7006(16)30017-3 -
European Journal of Pharmacology Jan 2016Major depressive disorder is a disabling psychiatric condition that causes a significant burden on individuals and society. There is still a lack of a clear... (Review)
Review
Major depressive disorder is a disabling psychiatric condition that causes a significant burden on individuals and society. There is still a lack of a clear understanding of the neuropathological changes associated with this illness and the efficacy of antidepressants is still far from optimal. Research into antidepressant therapies has evolved from serendipitous observation in human trials, but more than 60 years after the first monoaminergic antidepressants emerged they remain the mainstay for treating depression. However, glutamatergic modulators such as ketamine became the forefront of antidepressant exploration, especially for treatment-resistant depression and suicidal ideation. The glutamatergic hypothesis of depression is not new, however other NMDA receptor modulators do not seem to share the rapid and sustained effects of ketamine, suggesting that a unique combination of intracellular targets might be involved in its effect. Interestingly, inflammation can impact the glutamatergic system enhancing excitotoxicity and decreasing neuroplasticity. The points of convergence between the inflammatory and glutamatergic hypotheses of depression are not completely established, especially regarding the effects of fast-acting antidepressants. In this review, we discuss the most recent research surrounding glutamatergic fast-acting antidepressants, capable of modulating cellular plasticity and synaptogenesis and the potential of anti-inflammatory compounds evaluated from a different perspective. The combination of innovative ideas plus improvements on the discoveries made so far might lead to advances in antidepressant research with the promise of finding compounds that are both effective and fast-acting, even in patients who have tried other therapies with limited success.
Topics: Animals; Antidepressive Agents; Depressive Disorder; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Humans
PubMed: 26703867
DOI: 10.1016/j.ejphar.2015.12.029 -
Neuropharmacology Jul 2018Depressive disorders constitute a set of debilitating diseases with psychological, societal, economic and humanitarian consequences for millions of people worldwide.... (Review)
Review
Depressive disorders constitute a set of debilitating diseases with psychological, societal, economic and humanitarian consequences for millions of people worldwide. Scientists are beginning to understand the reciprocal communication between the brain and the rest of the body in the etiology of these diseases. In particular, scientists have noted a connection between depressive disorders, which are primarily seen as brain-based, and, insulin resistance (IR), a modifiable metabolic inflammatory state that is typically seen as peripheral. We highlight evidence showing how treating IR, with drugs or behavioral interventions, may ameliorate or possibly prevent, depressive disorders and their long-term consequences at various stages of the life course. This article is part of the Special Issue entitled 'Metabolic Impairment as Risk Factors for Neurodegenerative Disorders.'
Topics: Animals; Depressive Disorder; Humans; Insulin Resistance
PubMed: 29180223
DOI: 10.1016/j.neuropharm.2017.11.038 -
L'Encephale Feb 2016
Topics: Antidepressive Agents; Depressive Disorder; History, 20th Century; History, Ancient; Humans; Pain
PubMed: 26879251
DOI: 10.1016/S0013-7006(16)30013-6 -
European Psychiatry : the Journal of... Mar 2016Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric... (Review)
Review
PURPOSE
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.
METHODS
We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.
RESULTS
We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.
DISCUSSION
The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.
CONCLUSION
Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
Topics: Antidepressive Agents; Chronic Disease; Combined Modality Therapy; Depression; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Europe; Humans; Outcome and Process Assessment, Health Care; Psychiatric Status Rating Scales; Psychotherapy
PubMed: 26854984
DOI: 10.1016/j.eurpsy.2015.12.003 -
Clinical Psychology & Psychotherapy 2014Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial,... (Review)
Review
UNLABELLED
Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients.
KEY PRACTITIONER MESSAGE
In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.
Topics: Attitude to Health; Depressive Disorder; Female; Humans; Male; Mindfulness; Narrative Therapy; Neoplasms
PubMed: 23716367
DOI: 10.1002/cpp.1847 -
Acta Oncologica (Stockholm, Sweden) Feb 2017Although depression and mood-related disorders are common in persons with cancer, these conditions remain frequently overlooked in clinical practice. Negative... (Review)
Review
BACKGROUND
Although depression and mood-related disorders are common in persons with cancer, these conditions remain frequently overlooked in clinical practice. Negative consequences of depressive disorder spectrum have been reported (e.g. suicidal ideation, increase physical complications and somatic symptoms, negative influence on prognosis), indicating the need for routine screening, assessment and management.
METHODS
A search of the major databases (Medline, Embase, PsycLIT, PsycINFO, and the Cochrane Library) was conducted on the reviews and meta-analyses available in order to summarize relevant data concerning depressive disorders spectrum in terms of prevalence, risk factors, and screening and assessment among patients with cancer across the trajectory of the disease.
RESULTS
The data show a prevalence of depression and depressive disorders between 5% and 60% according to the different diagnostic criteria, the tools used in the studies (e.g. semi-structured psychiatric interview and psychometric questionnaires), as well as the stage and type of cancer. Furthermore, despite the significant health care resources devoted to cancer care and the importance of addressing depressive symptoms, assessment and management of depressive spectrum disorders in cancer patients remains suboptimal.
CONCLUSIONS
Routine screening and adequate assessment of depressive spectrum disorders is necessary in patients with cancer in order to effectively manage the multifaceted and complex consequences on cancer care.
Topics: Depressive Disorder; Humans; Neoplasm Staging; Neoplasms; Prevalence; Risk Factors
PubMed: 28140731
DOI: 10.1080/0284186X.2016.1266090