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EBioMedicine Apr 2023Major depressive disorder is one of the most disabling mental disorders worldwide. Increasing preclinical and clinical studies have highlighted that compositional and... (Review)
Review
Major depressive disorder is one of the most disabling mental disorders worldwide. Increasing preclinical and clinical studies have highlighted that compositional and functional (e.g., metabolite) changes in gut microbiota, known as dysbiosis, are associated with the onset and progression of depression via regulating the gut-brain axis. However, the gut microbiota and their metabolites present a double-edged sword in depression. Dysbiosis is involved in the pathogenesis of depression while, at the same time, offering a novel therapeutic target. In this review, we describe the association between dysbiosis and depression, drug-microbiota interactions in antidepressant treatment, and the potential health benefits of microbial-targeted therapeutics in depression, including dietary interventions, fecal microbiota transplantation, probiotics, prebiotics, synbiotics, and postbiotics. With the emergence of microbial research, we describe a new direction for future research and clinical treatment of depression.
Topics: Humans; Gastrointestinal Microbiome; Depression; Dysbiosis; Depressive Disorder, Major; Probiotics; Fecal Microbiota Transplantation
PubMed: 36963238
DOI: 10.1016/j.ebiom.2023.104527 -
Neuron Jul 2020Depression represents the number one cause of disability worldwide and is often fatal. Inflammatory processes have been implicated in the pathophysiology of depression.... (Review)
Review
Depression represents the number one cause of disability worldwide and is often fatal. Inflammatory processes have been implicated in the pathophysiology of depression. It is now well established that dysregulation of both the innate and adaptive immune systems occur in depressed patients and hinder favorable prognosis, including antidepressant responses. In this review, we describe how the immune system regulates mood and the potential causes of the dysregulated inflammatory responses in depressed patients. However, the proportion of never-treated major depressive disorder (MDD) patients who exhibit inflammation remains to be clarified, as the heterogeneity in inflammation findings may stem in part from examining MDD patients with varied interventions. Inflammation is likely a critical disease modifier, promoting susceptibility to depression. Controlling inflammation might provide an overall therapeutic benefit, regardless of whether it is secondary to early life trauma, a more acute stress response, microbiome alterations, a genetic diathesis, or a combination of these and other factors.
Topics: Affect; Antidepressive Agents; Depression; Depressive Disorder, Major; Humans; Immune System; Inflammation
PubMed: 32553197
DOI: 10.1016/j.neuron.2020.06.002 -
JAMA Dec 2016Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.
OBJECTIVE
To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.
DATA SOURCES AND STUDY SELECTION
Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.
DATA EXTRACTION AND SYNTHESIS
Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.
MAIN OUTCOMES AND MEASURES
Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.
RESULTS
Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.
CONCLUSIONS AND RELEVANCE
In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
Topics: Depression; Depressive Disorder; Humans; Longitudinal Studies; Prevalence; Students, Medical; Suicidal Ideation
PubMed: 27923088
DOI: 10.1001/jama.2016.17324 -
Neuroscience May 2016Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms... (Review)
Review
Major depressive disorder (MDD) will affect one out of every five people in their lifetime and is the leading cause of disability worldwide. Nevertheless, mechanisms associated with the pathogenesis of MDD have yet to be completely understood and current treatments remain ineffective in a large subset of patients. In this review, we summarize the most recent discoveries and insights for which parallel findings have been obtained in human depressed subjects and rodent models of mood disorders in order to examine the potential etiology of depression. These mechanisms range from synaptic plasticity mechanisms to epigenetics and the immune system where there is strong evidence to support a functional role in the development of specific depression symptomology. Ultimately we conclude by discussing how novel therapeutic strategies targeting central and peripheral processes might ultimately aid in the development of effective new treatments for MDD and related stress disorders.
Topics: Animals; Behavior, Animal; Brain; Depression; Depressive Disorder, Major; Disease Models, Animal; Humans; Mice; Microglia; Neuronal Plasticity; Neurons; Rats; Synapses
PubMed: 26037806
DOI: 10.1016/j.neuroscience.2015.05.053 -
Maturitas Oct 2014Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments... (Review)
Review
Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments in the form of medications or psychotherapy are available, but a large proportion of those treated fail to respond fully, and relapse or recurrence of symptoms is frequent among those who recover. Hence, successful prevention would avoid these negative outcomes. This paper selectively reviews currently available observational and trial data on the prevention of depression. It initially reviews risk factors associated with depression, and then discusses strategies for primary (including universal, selective and indicated), secondary and tertiary prevention. Currently available evidence suggests that selective and indicated preventive interventions are feasible and initial results look promising. Existing trial data indicate that ongoing antidepressant treatments reduce the risk of relapse and recurrence of symptoms, but benefits may not extend beyond two or three years. At this point in time, no interventions have been shown to reduce the long term complications associated with depression. Mental health professionals will need to work collaboratively to develop primary, secondary and tertiary preventive interventions that are effective at targeting relevant risk factors systematically and that can be easily adopted into clinical practice.
Topics: Aged; Antidepressive Agents; Depression; Depressive Disorder; Humans; Psychotherapy; Recurrence; Risk Factors
PubMed: 24713453
DOI: 10.1016/j.maturitas.2014.03.005 -
International Journal of Molecular... Sep 2019Depression has become one of the most severe psychiatric disorders and endangers the health of living beings all over the world. In order to explore the molecular... (Review)
Review
Depression has become one of the most severe psychiatric disorders and endangers the health of living beings all over the world. In order to explore the molecular mechanism that underlies depression, different kinds of animal models of depression are used in laboratory experiments. However, a credible and reasonable animal model that is capable of imitating the pathologic mechanism of depression in mankind has yet to be found, resulting in a barrier to further investigation of depression. Nevertheless, it is possible to explain the pathologic mechanism of depression to a great extent by a rational modeling method and behavioral testing. This review aims to provide a reference for researchers by comparing the advantages and disadvantages of some common animal depression models.
Topics: Animals; Behavior, Animal; Depression; Depressive Disorder; Disease Models, Animal; Humans
PubMed: 31569393
DOI: 10.3390/ijms20194827 -
AMA Journal of Ethics Jul 2021Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as...
Too many men who suffer from depression remain undiagnosed. While men are diagnosed with depression at half the rate of women, they die by suicide 3 to 4 times as frequently. Gendered processes of socialization affect how some boys and men express depression. Notably, gender disparities in diagnosis disappear when "male-typical" symptoms of depression are incorporated. Historically and to this day, masculinities have created barriers to care. Addressing disparities in depression diagnoses and treatment requires making psychological services affordable, adopting collaborative care models, revisiting sex as a risk factor for depression, and reexamining major depressive disorder's diagnostic criteria.
Topics: Anxiety; Depression; Depressive Disorder, Major; Female; Humans; Male; Suicide
PubMed: 34351273
DOI: 10.1001/amajethics.2021.586 -
The New England Journal of Medicine Feb 2019A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative... (Review)
Review
A 45-year-old woman with hypothyroidism that has been treated with a stable dose of levothyroxine presents to her primary care provider with depressed mood, negative feelings about herself, poor sleep, low appetite, poor concentration, and lack of energy. These symptoms began several months ago during a conflict with her partner. Although she has been able to continue with work and life responsibilities, she feels sadness most days and occasionally thinks that she would be better off dead. How would you evaluate and treat this patient?
Topics: Antidepressive Agents; Combined Modality Therapy; Depression; Depressive Disorder; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Middle Aged; Practice Guidelines as Topic; Primary Health Care; Psychotherapy
PubMed: 30726688
DOI: 10.1056/NEJMcp1712493 -
Neurotherapeutics : the Journal of the... Jul 2022Deep brain stimulation has been extensively studied as a therapeutic option for treatment-resistant depression (TRD). DBS across different targets is associated with on... (Review)
Review
Deep brain stimulation has been extensively studied as a therapeutic option for treatment-resistant depression (TRD). DBS across different targets is associated with on average 60% response rates in previously refractory chronically depressed patients. However, response rates vary greatly between patients and between studies and often require extensive trial-and-error optimizations of stimulation parameters. Emerging evidence from tractography imaging suggests that targeting combinations of white matter tracts, rather than specific grey matter regions, is necessary for meaningful antidepressant response to DBS. In this article, we review efficacy of various DBS targets for TRD, which networks are involved in their therapeutic effects, and how we can use this information to improve targeting and programing of DBS for individual patients. We will also highlight how to integrate these DBS network findings into developing adaptive stimulation and optimal trial designs.
Topics: Humans; Deep Brain Stimulation; Depression; Depressive Disorder, Treatment-Resistant; White Matter; Antidepressive Agents
PubMed: 35817944
DOI: 10.1007/s13311-022-01270-3 -
Current Psychiatry Reports Nov 2019We give an overview of recent developments on psychological treatments of depression in primary care. (Review)
Review
PURPOSE OF REVIEW
We give an overview of recent developments on psychological treatments of depression in primary care.
RECENT FINDINGS
In recent years, it has become clear that psychotherapies can effectively be delivered through e-health applications. Furthermore, several studies in low and middle income countries have shown that lay health counselors can effectively deliver psychological therapies. Behavioral activation, a relatively simple form of therapy, has been found to be as effective as cognitive behavior therapy. Treatment of subthreshold depression has been found to not only reduce depressive symptoms but also prevent the onset of major depression. In addition, therapies are effective in older adults, patients with general medical disorders and in perinatal depression. Psychological therapies are effective in the treatment of depression in primary care, have longer lasting effects than drugs, are preferred by the majority of patients, and can be applied flexibly with different formats and across different target groups.
Topics: Cognitive Behavioral Therapy; Depression; Depressive Disorder, Major; Humans; Primary Health Care; Psychotherapy
PubMed: 31760505
DOI: 10.1007/s11920-019-1117-x