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Psychiatria Polska Jun 2020Cognitive dysfunctions are part of the symptomatology of depressive disorders but they may persist even after the patient reaches symptomatic remission. As persistent... (Review)
Review
Cognitive dysfunctions are part of the symptomatology of depressive disorders but they may persist even after the patient reaches symptomatic remission. As persistent symptoms of depression, cognitive dysfunctions may inhibit and restrict the patient's functioning in many spheres and significantly impair its quality. In addition, they increase the risk of somatic diseases and contribute to the increase of benefits disbursed from state aid. Furthermore, it is a factor negatively affecting the prognosis of depressive disorders because it increases the risk of recurrence of depression and reduces the susceptibility to pharmacotherapy. Neural network dysfunctions and changes in morphometry in particular areas of the brain are responsible for the persistence of cognitive deficits after MDD treatment. Most of currently used thymoleptics facilitate remission of depressive disorders but do not lead to reversal of cognitive deficits. There is growing evidence that antidepressants used in clinical practice can improve cognitive functions regardless of their impact on the affective component. The aim of the present study is to discuss the neurobiological mechanisms of cognitive dysfunctions and their clinical symptoms, and to present therapeutic prospects for patients with persistent cognitive dysfunctions in depressive disorders.
Topics: Antidepressive Agents; Cognition; Cognitive Dysfunction; Depression; Depressive Disorder, Major; Female; Humans; Male
PubMed: 33038880
DOI: 10.12740/PP/OnlineFirst/105415 -
The European Journal of Neuroscience Jan 2021Major depressive disorder (MDD) is a chronic and recurrent psychiatric condition characterized by depressed mood, social isolation and anhedonia. It will affect 20% of... (Review)
Review
Major depressive disorder (MDD) is a chronic and recurrent psychiatric condition characterized by depressed mood, social isolation and anhedonia. It will affect 20% of individuals with considerable economic impacts. Unfortunately, 30-50% of depressed individuals are resistant to current antidepressant treatments. MDD is twice as prevalent in women and associated symptoms are different. Depression's main environmental risk factor is chronic stress, and women report higher levels of stress in daily life. However, not every stressed individual becomes depressed, highlighting the need to identify biological determinants of stress vulnerability but also resilience. Based on a reverse translational approach, rodent models of depression were developed to study the mechanisms underlying susceptibility vs resilience. Indeed, a subpopulation of animals can display coping mechanisms and a set of biological alterations leading to stress resilience. The aetiology of MDD is multifactorial and involves several physiological systems. Exacerbation of endocrine and immune responses from both innate and adaptive systems are observed in depressed individuals and mice exhibiting depression-like behaviours. Increasing attention has been given to neurovascular health since higher prevalence of cardiovascular diseases is found in MDD patients and inflammatory conditions are associated with depression, treatment resistance and relapse. Here, we provide an overview of endocrine, immune and vascular changes associated with stress vulnerability vs. resilience in rodents and when available, in humans. Lack of treatment efficacy suggests that neuron-centric treatments do not address important causal biological factors and better understanding of stress-induced adaptations, including sex differences, could contribute to develop novel therapeutic strategies including personalized medicine approaches.
Topics: Adaptation, Psychological; Animals; Antidepressive Agents; Depression; Depressive Disorder, Major; Female; Humans; Male; Mice; Neurobiology; Stress, Psychological
PubMed: 31421056
DOI: 10.1111/ejn.14547 -
Zeitschrift Fur Kinder- Und... Nov 2019Depressive symptoms have long been associated with abnormalities in neural processing of reward. However, no review has yet consolidated evidence of such deficits in... (Review)
Review
Depressive symptoms have long been associated with abnormalities in neural processing of reward. However, no review has yet consolidated evidence of such deficits in adolescent depression, integrating findings across neuroimaging modalities, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). The current review found consistent evidence of reduced striatal responses in anticipation and upon receipt of rewards, and blunted feedback-related negativity (FRN) potentials associated with depression in adolescence, consistent with the adult literature. Furthermore, while these occurred in currently depressed adolescents, they were also found to be predictive of the onset of depressive symptoms in longitudinal studies with community-based adolescent samples. This paper makes recommendations for future work to continue to elucidate this relationship, a greater understanding of which may lead to more targeted and efficacious treatments for depression in adolescence.
Topics: Adolescent; Depression; Depressive Disorder; Electroencephalography; Humans; Magnetic Resonance Imaging; Neuroimaging; Reward
PubMed: 30957688
DOI: 10.1024/1422-4917/a000663 -
Journal of Integrative Neuroscience Jul 2022Depression is a major public health issue in numerous countries, with around 300 million people worldwide suffering from it. Typically, depressed patients are treated... (Review)
Review
Depression is a major public health issue in numerous countries, with around 300 million people worldwide suffering from it. Typically, depressed patients are treated with antidepressants or psychological therapy or a combination of both. However, there are some limitations associated with these therapies and as a result, over the past decades a number of alternative or complementary therapies have been developed. Exercise is one such option that is supported by published extensive basic and clinical research data. The aim of this review was to examine the beneficial effects of exercise in depression. Physical activity and exercise have been shown to be effective in treating mild-to-moderate depression and in reducing mortality and symptoms of major depression. However, physical activity and exercise are still underused in clinical practice. This review attempts to propose a framework to help clinicians in their decision-making process, how to incorporate physical activity in their toolkit of potential therapeutic responses for depressed patients. We first summarize the interactions between depression and physical activities, with a particular focus on the potential antidepressant physiological effects of physical activity. We then identify some of the barriers blocking physical activity from being used to fight depression. Finally, we present several perspectives and ideas that can help in optimizing mitigation strategies to challenge these barriers, including actions on physical activity representations, ways to increase the accessibility of physical activity, and the potential of technology to help both clinicians and patients.
Topics: Antidepressive Agents; Anxiety; Depression; Depressive Disorder, Major; Exercise; Humans
PubMed: 36137954
DOI: 10.31083/j.jin2105132 -
Molecular Biology Reports Jan 2020Major depressive disorder (MDD) is considered a serious public health issue that adversely impacts an individual's quality of life and contributes significantly to the... (Review)
Review
Major depressive disorder (MDD) is considered a serious public health issue that adversely impacts an individual's quality of life and contributes significantly to the global burden of disease. The clinical heterogeneity that exists among patients limits the ability of MDD to be accurately diagnosed and currently, a symptom-based approach is utilized in many cases. Due to the complex nature of this disorder, and lack of precise knowledge regarding the pathophysiology, effective management is challenging. The aetiology and pathophysiology of MDD remain largely unknown given the complex genetic and environmental interactions that are involved. Nonetheless, the aetiology and pathophysiology of MDD have been the subject of extensive research, and there is a vast body of literature that exists. Here we overview the key hypotheses that have been proposed for the neurobiology of MDD and highlight the need for a unified model, as many of these pathways are integrated. Key pathways discussed include neurotransmission, neuroinflammation, clock gene machinery pathways, oxidative stress, role of neurotrophins, stress response pathways, the endocannabinoid and endovanilloid systems, and the endogenous opioid system. We also describe the current management of MDD, and emerging novel therapies, with particular focus on patients with treatment-resistant depression (TRD).
Topics: Animals; Antidepressive Agents; Depression; Depressive Disorder, Major; Humans; Inflammation; Mice; Models, Biological; Neurotransmitter Agents; Oxidative Stress; Signal Transduction; Synapses
PubMed: 31612411
DOI: 10.1007/s11033-019-05129-3 -
JAMA Psychiatry Aug 2020The modern concept of depression arose from earlier diagnostic formulations of melancholia over the hundred years from the 1780s to the 1880s. In this historical sketch,... (Review)
Review
The modern concept of depression arose from earlier diagnostic formulations of melancholia over the hundred years from the 1780s to the 1880s. In this historical sketch, this evolution is traced from the writings of 12 authors outlining the central roles played by the concepts of faculty psychology and understandability. Five of the authors, writing from 1780 through the 1830s, including Cullen, Pinel, and Esquirol, defined melancholia as a disorder of intellect or judgment, a "partial insanity" often, but not always, associated with sadness. Two texts from the 1850s by Guislain, and Bucknill and Tuke were at the transition between paradigms. Both emphasized a neglected disorder-melancholia without delusions-arguing that it reflected a primary disorder of mood-not of intellect. In the final phase in the 1860s to 1880s, 5 authors (Griesinger, Sankey, Maudsley, Krafft-Ebing, and Kraepelin) all confronted the problem of the cause of delusional melancholia. Each author concluded that melancholia was a primary mood disorder and argued that the delusions emerged understandably from the abnormal mood. In this 100-year period, the explanation of delusional melancholia in faculty psychology terms reversed itself from an intellect to mood to a mood to intellect model. The great nosologists of the 19th century are often seen as creating our psychiatric disorders using a simple inductive process, clustering the symptoms, signs, and later the course of the patients. This history suggests 2 complexities to this narrative. First, in addition to bottom-up clinical studies, these nosologists were working top-down from theories of faculty psychology proposed by 18th century philosophers. Second, for patient groups experiencing disorders of multiple faculties, the nosologists used judgments about understandability to assign primary causal roles. This historical model suggests that the pathway from patient observation to the nosologic categories-the conceptual birth of our diagnostic categories-has been more complex than is often realized.
Topics: Depression; Depressive Disorder; History, 18th Century; History, 19th Century; Humans; Psychiatry
PubMed: 31995137
DOI: 10.1001/jamapsychiatry.2019.4709 -
JAMA Psychiatry Jun 2023Prenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Prenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression during pregnancy are needed.
OBJECTIVE
To evaluate depression improvement (symptoms and diagnosis) among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy (IPT) vs enhanced usual care (EUC).
DESIGN, SETTING, AND PARTICIPANTS
A prospective, evaluator-blinded, randomized clinical trial, the Care Project, was conducted among adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics. Participants were recruited between July 2017 and August 2021. Repeated measures follow-up occurred across pregnancy from baseline (mean [SD], 16.7 [4.2] gestational weeks) through term. Pregnant participants were randomized to IPT or EUC and included in intent-to-treat analyses.
INTERVENTIONS
Treatment comprised an engagement session and 8 active sessions of brief IPT (MOMCare) during pregnancy. EUC included engagement and maternity support services.
MAIN OUTCOMES AND MEASURES
Two depression symptom scales, the 20-item Symptom Checklist and the Edinburgh Postnatal Depression Scale, were assessed at baseline and repeatedly across pregnancy. Structured Clinical Interview for DSM-5 ascertained major depressive disorder (MDD) at baseline and the end of gestation.
RESULTS
Of 234 participants, 115 were allocated to IPT (mean [SD] age, 29.7 [5.9] years; 57 [49.6%] enrolled in Medicaid; 42 [36.5%] had current MDD; 106 [92.2%] received intervention) and 119 to EUC (mean [SD] age, 30.1 [5.9] years; 62 [52.1%] enrolled in Medicaid; 44 [37%] had MDD). The 20-item Symptom Checklist scores improved from baseline over gestation for IPT but not EUC (d = 0.57; 95% CI, 0.22-0.91; mean [SD] change for IPT vs EUC: 26.7 [1.14] to 13.6 [1.40] vs 27.1 [1.12] to 23.5 [1.34]). IPT participants more rapidly improved on Edinburgh Postnatal Depression Scale compared with EUC (d = 0.40; 95% CI, 0.06-0.74; mean [SD] change for IPT vs EUC: 11.4 [0.38] to 5.4 [0.57] vs 11.5 [0.37] to 7.6 [0.55]). MDD rate by end of gestation had decreased significantly for IPT participants (7 [6.1%]) vs EUC (31 [26.1%]) (odds ratio, 4.99; 95% CI, 2.08-11.97).
CONCLUSIONS AND RELEVANCE
In this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics. As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers' mental health and the developing fetus.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03011801.
Topics: Adult; Humans; Female; Pregnancy; Depression; Depressive Disorder, Major; Treatment Outcome; Prospective Studies; Psychotherapy, Brief
PubMed: 37074698
DOI: 10.1001/jamapsychiatry.2023.0702 -
Neuropsychiatrie : Klinik, Diagnostik,... Sep 2019Major depressive disorder is characterized by changes in the emotional state, e. g. the diminished experience of positive emotions, as well as cognitive impairments... (Review)
Review
Major depressive disorder is characterized by changes in the emotional state, e. g. the diminished experience of positive emotions, as well as cognitive impairments such as concentration and memory difficulties. These emotional and cognitive dysfunctions are closely interrelated and play a key role for the development and maintenance of depressive symptoms. For instance, patients with depression show negatively biased information processing that affects attention and memory as well as their reaction to feedback. In addition, there is an increased motivation to avoid negatively evaluated conditions and at the same time a reduced motivation to approach positive goals. Furthermore, depressed patients often show a specific style of thinking, called rumination, which involves repeated, intensive thinking about the causes, consequences and symptoms of one's own negative feelings. In this review, the different relationships between emotional, motivational and cognitive symptoms of depressive patients will be presented and the influence of their interaction on cognitive performance will be discussed. The highlighted clinical relevance of emotional-cognitive dysfunctions should be considered more often in therapeutic interventions for depressed patients.
Topics: Attentional Bias; Cognitive Dysfunction; Depression; Depressive Disorder, Major; Emotions; Humans; Memory; Motivation; Rumination, Cognitive
PubMed: 30875025
DOI: 10.1007/s40211-019-0307-4 -
Archives of Women's Mental Health Apr 2020Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has... (Randomized Controlled Trial)
Randomized Controlled Trial
Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among people with mood and anxiety disorders, but limited studies reported the effectiveness of MBCT on perinatal comorbid conditions. This study aimed to examine the effects of an 8-week MBCT intervention on pregnant women with comorbid depression and anxiety. In this randomized controlled study, 38 pregnant women with a diagnosis of depression and varying levels of comorbid anxiety disorders were randomly assigned to either MBCT or a control group. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, Emotion Regulation Questionnaire, and Scales of Psychological Wellbeing were used as outcome measures at baseline, after MBCT, and through 1-month follow-up. Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1 month. Results provide cross-cultural support for MBCT as a treatment for depression and anxiety in pregnant women. This brief and non-pharmacological treatment can be used to improve maternal psychological health.
Topics: Adult; Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Comorbidity; Depression; Depressive Disorder; Female; Humans; Iran; Mindfulness; Pregnancy; Psychiatric Status Rating Scales; Surveys and Questionnaires; Treatment Outcome
PubMed: 30982086
DOI: 10.1007/s00737-019-00962-8 -
Fortschritte Der Neurologie-Psychiatrie Apr 2022
Topics: Depression; Depressive Disorder; Humans; Parkinson Disease
PubMed: 35443281
DOI: 10.1055/a-1683-1840