-
Biomolecules Jul 2021The brain-gut-microbiome axis is a bidirectional communication pathway between the gut microbiota and the central nervous system. The growing interest in the gut... (Review)
Review
The brain-gut-microbiome axis is a bidirectional communication pathway between the gut microbiota and the central nervous system. The growing interest in the gut microbiota and mechanisms of its interaction with the brain has contributed to the considerable attention given to the potential use of probiotics, prebiotics and postbiotics in the prevention and treatment of depressive disorders. This review discusses the up-to-date findings in preclinical and clinical trials regarding the use of pro-, pre- and postbiotics in depressive disorders. Studies in rodent models of depression show that some of them inhibit inflammation, decrease corticosterone level and change the level of neurometabolites, which consequently lead to mitigation of the symptoms of depression. Moreover, certain clinical studies have indicated improvement in mood as well as changes in biochemical parameters in patients suffering from depressive disorders.
Topics: Brain; Depressive Disorder; Gastrointestinal Microbiome; Humans; Inflammation; Prebiotics; Probiotics
PubMed: 34356624
DOI: 10.3390/biom11071000 -
Australasian Psychiatry : Bulletin of... Dec 2019Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder... (Review)
Review
OBJECTIVE
Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context.
CONCLUSIONS
Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy.
Topics: Borderline Personality Disorder; Comorbidity; Depressive Disorder, Major; Diagnosis, Differential; Humans
PubMed: 31573324
DOI: 10.1177/1039856219878643 -
The New England Journal of Medicine Jul 2021
Review
Topics: Adolescent; Antidepressive Agents; Depressive Disorder; Depressive Disorder, Major; Humans; Psychotherapy; Selective Serotonin Reuptake Inhibitors; Suicide
PubMed: 34320289
DOI: 10.1056/NEJMra2033475 -
Depression and Anxiety Feb 2020Varying conceptualizations of treatment-resistant depression (TRD) have made translating research findings or systematic reviews into clinical practice guidelines...
BACKGROUND
Varying conceptualizations of treatment-resistant depression (TRD) have made translating research findings or systematic reviews into clinical practice guidelines challenging and inconsistent.
METHODS
We conducted a review for the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality to clarify how experts and investigators have defined TRD and to review systematically how well this definition comports with TRD definitions in clinical trials through July 5, 2019.
RESULTS
We found that no consensus definition existed for TRD. The most common TRD definition for major depressive disorder required a minimum of two prior treatment failures and confirmation of prior adequate dose and duration. The most common TRD definition for bipolar disorder required one prior treatment failure. No clear consensus emerged on defining adequacy of either dose or duration. Our systematic review found that only 17% of intervention studies enrolled samples meeting the most frequently specified criteria for TRD. Depressive outcomes and clinical global impressions were commonly measured; functional impairment and quality-of-life tools were rarely used.
CONCLUSIONS
Two key steps are critical to advancing TRD research: (a) Developing a consensus definition of TRD that addresses how best to specify the number of prior treatment failures and the adequacy of dose and duration; and (b) identifying a core package of outcome measures that can be applied in a standardized manner. Our recommendations about stronger approaches to designing and conducting TRD research will foster better evidence to translate into clearer guidelines for treating patients with this serious condition.
Topics: Antidepressive Agents; Bipolar Disorder; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Humans; Quality of Life; United States
PubMed: 31638723
DOI: 10.1002/da.22968 -
Neuroscience and Biobehavioral Reviews Oct 2019Depression is a serious neurological disorder characterized by strong loss of interest, possibly leading to suicide. According to the World Health Organization, more... (Review)
Review
Depression is a serious neurological disorder characterized by strong loss of interest, possibly leading to suicide. According to the World Health Organization, more than 300 million people worldwide suffer from this disorder, being the leading cause of disability. The advancements in electroencephalography (EEG) make it a powerful tool for non-invasive studies on neurological disorders including depression. Scientific community has used EEG to better understand the mechanisms behind the disorder and find biomarkers, which are characteristics that can be precisely measured in order to identify or diagnose a disorder. This work presents a systematic mapping of recent studies ranging from 2014 to the end of 2018 which use non-invasive EEG to detect depression biomarkers. Our research has analyzed more than 250 articles and we discuss the findings and promising biomarkers of 42 studies, finding that the depressed brain appear to have a more random network structure, also finding promising features for diagnostic, such as, gamma band and signal complexity; among others which may detect specific depression-related symptoms such as suicidal ideation.
Topics: Biomarkers; Brain Waves; Depressive Disorder; Electroencephalography; Humans
PubMed: 31400570
DOI: 10.1016/j.neubiorev.2019.07.021 -
Anaesthesia Apr 2021Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal... (Review)
Review
Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal outcomes, and mental disorder remains one of the leading causes of maternal death in the UK. Women with mental ill health face difficult decisions in balancing risks and benefits of treatment. Stigma related to mental disorder may lead to non-engagement with maternity care. Some disorders bring specific challenges for anaesthetists working in maternity settings and it is vital that anaesthetists have knowledge of these disorders so they may offer care which is sensitive and appropriate.
Topics: Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Electroconvulsive Therapy; Female; Humans; Mental Disorders; Postpartum Period; Pregnancy; Pregnancy Complications
PubMed: 33682099
DOI: 10.1111/anae.15424 -
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 -
The Journal of Clinical Psychiatry Mar 2021Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the...
OBJECTIVE
Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the share of TRD in the burden of medication-treated major depressive disorder (MDD) using the most commonly accepted definition of TRD and a novel bottom-up approach.
METHODS
Prevalence and health care burden of TRD were estimated by synthetizing inputs across 4 similarly designed claims studies in adults covered by Medicare, Medicaid, commercial plans, and the US Veterans Health Administration (VHA). Productivity (absenteeism and presenteeism) and unemployment burden were estimated based on inputs from a study conducted with data from the Kantar National Health and Wellness Survey (NHWS; 2017). A targeted literature search for additional inputs was performed. A cost model was developed to estimate the burden of TRD and medication-treated DSM-5-defined MDD in the United States. Study outcomes were the 12-month prevalence of TRD and the annual health care, productivity, and unemployment burden of TRD and medication-treated MDD in the United States.
RESULTS
The estimated 12-month prevalence of medication-treated MDD in the United States was 8.9 million adults, and 2.8 million (30.9%) had TRD. The total annual burden of medication-treated MDD among the US population was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. The share of TRD was 56.6% ($25.8 billion) of the health care burden, 47.7% ($8.7 billion) of the unemployment burden, and 32.2% ($9.3 billion) of the productivity burden of medication-treated MDD.
CONCLUSIONS
TRD is associated with disproportionate health care costs and unemployment, suggesting potentially large economic and societal gains with effective management.
Topics: Absenteeism; Adult; Antidepressive Agents; Cost of Illness; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Health Care Costs; Humans; Prevalence; United States
PubMed: 33989464
DOI: 10.4088/JCP.20m13699 -
Australasian Psychiatry : Bulletin of... Jun 2020An incorrect false positive diagnosis of melancholia can lead to inappropriate treatment and illness prolongation. This paper therefore seeks to introduce the concept of... (Review)
Review
OBJECTIVE
An incorrect false positive diagnosis of melancholia can lead to inappropriate treatment and illness prolongation. This paper therefore seeks to introduce the concept of 'pseudo-melancholia' to capture such instances and provide clinical examples of contributing at-risk scenarios.
METHODS
The author draws on clinical experience to provide exemplars of circumstances most risking a false positive diagnosis of melancholia.
RESULTS
Pseudo-melancholia can result from invalid measures of melancholia and from several functional and organic conditions presenting with suggested melancholic features.
CONCLUSIONS
Recognising high-risk pseudo-melancholia scenarios has the potential to advance a change in diagnostic formulation, provide a more diagnosis-specific intervention and so avert a secondary diagnosis of 'treatment resistant depression'.
Topics: Depressive Disorder; Depressive Disorder, Treatment-Resistant; Diagnosis, Differential; Diagnostic Errors; Humans
PubMed: 32157900
DOI: 10.1177/1039856220908167 -
Annual Review of Psychology Jan 2020Depression remains one of the most prevalent psychiatric disorders, with many patients not responding adequately to available treatments. Chronic or early-life stress is... (Review)
Review
Depression remains one of the most prevalent psychiatric disorders, with many patients not responding adequately to available treatments. Chronic or early-life stress is one of the key risk factors for depression. In addition, a growing body of data implicates chronic inflammation as a major player in depression pathogenesis. More recently, the gut microbiota has emerged as an important regulator of brain and behavior and also has been linked to depression. However, how this holy trinity of risk factors interact to maintain physiological homeostasis in the brain and body is not fully understood. In this review, we integrate the available data from animal and human studies on these three factors in the etiology and progression of depression. We also focus on the processes by which this microbiota-immune-stress matrix may influence centrally mediated events and on possible therapeutic interventions to correct imbalances in this triune.
Topics: Animals; Depressive Disorder; Gastrointestinal Microbiome; Humans; Inflammation; Stress, Psychological
PubMed: 31567042
DOI: 10.1146/annurev-psych-122216-011613