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Turkish Journal of Medical Sciences Feb 2023Major depressive disorder (MDD) is a significant cause of workforce loss, and is associated with cognitive impairments which can continue even after the elimination of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Major depressive disorder (MDD) is a significant cause of workforce loss, and is associated with cognitive impairments which can continue even after the elimination of mood and behavioural symptoms. The aim of this study was to investigate the benefit of transcranial magnetic stimulation (TMS) on cognitive functions in treatment resistant depression.
METHODS
This randomised controlled clinical trial was conducted at a university hospital, department of psychiatry (tertiary centre) between October 2019 and July 2020. The study included 30 patients with depressive disorder, aged 18-50 years, who did not respond to at least two antidepressant medications for at least 8 weeks (one drug used was serotonin norepinephrine reuptake inhibitor [SNRI]; and 15 healthy control subjects. The patients were separated into two equal groups in a double-blind, random manner, and 20 sessions of repeated TMS was applied to one group, and 20 sessions of sham TMS to the other. The Montgomery Asberg Depression Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), Stroop test, Wisconsin Card Sorting Test (WCST), Digit Span Test (DST), Trail Making Test A-B, and Verbal Memory Processes Test (VMPT) were applied to the patients before and after the TMS procedure.
RESULTS
The decrease in the HAM-D score was greater in the active magnetic stimulation (25 trains, 10 Hz, 110% motor threshold intensity) group, and with the exception of verbal memory processes, better performance was obtained by the active magnetic stimulation group than the sham group in the cognitive function tests.
DISCUSSION
TMS was seen toimprove the cognitive defects present in the active phase of treatment-resistant depression, and therefore TMS could provide early improvement in cognitive functions in clinical use. Key words: Depression, transcranial magnetic stimulation, neurocognitive functi.
Topics: Humans; Transcranial Magnetic Stimulation; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Depression; Psychiatric Status Rating Scales; Treatment Outcome; Double-Blind Method; Cognition
PubMed: 36945926
DOI: 10.55730/1300-0144.5580 -
Translational Psychiatry Sep 2023Treatment response and resistance in major depressive disorder (MDD) are suggested to be heritable. Due to significant challenges in defining treatment-related...
Treatment response and resistance in major depressive disorder (MDD) are suggested to be heritable. Due to significant challenges in defining treatment-related phenotypes, our understanding of their genetic bases is limited. This study aimed to derive a stringent definition of treatment resistance and to investigate the genetic overlap between treatment response and resistance in MDD. Using electronic medical records on the use of antidepressants and electroconvulsive therapy (ECT) from Swedish registers, we derived the phenotype of treatment-resistant depression (TRD) and non-TRD within ~4500 individuals with MDD in three Swedish cohorts. Considering antidepressants and lithium are first-line treatment and augmentation used for MDD, respectively, we generated polygenic risk scores (PRS) of antidepressants and lithium response for individuals with MDD and evaluated their associations with treatment resistance by comparing TRD with non-TRD. Among 1778 ECT-treated MDD cases, nearly all (94%) used antidepressants before their first ECT and the vast majority had at least one (84%) or two (61%) antidepressants of adequate duration, suggesting these MDD cases receiving ECT were resistant to antidepressants. We did not observe a significant difference in the mean PRS of antidepressant response between TRD and non-TRD; however, we found that TRD cases had a significantly higher PRS of lithium response compared to non-TRD cases (OR = 1.10-1.12 under various definitions). The results support the evidence of heritable components in treatment-related phenotypes and highlight the overall genetic profile of lithium-sensitivity in TRD. This finding further provides a genetic explanation for lithium efficacy in treating TRD.
Topics: Humans; Depressive Disorder, Major; Lithium; Antidepressive Agents; Electroconvulsive Therapy; Depressive Disorder, Treatment-Resistant
PubMed: 37770441
DOI: 10.1038/s41398-023-02602-3 -
The Psychoanalytic Quarterly 2024This paper explores how the film illuminates psychoanalytic understandings of melancholia and mourning. The author attempts to unwind the complicated character of...
This paper explores how the film illuminates psychoanalytic understandings of melancholia and mourning. The author attempts to unwind the complicated character of melancholia, using Freud as an initial point of orientation, then relying on a few ideas from Klein and later writers. The paper attempts to refine our understanding of the difference between absence and emptiness, especially the difference between being captured in the nothing or deadness of melancholic emptiness, on the one hand, and being alive enough to suffer the absence of a lost object, which bears a potential for mourning, on the other. The possibility of psychic tension between these states is explored. Some implications of the relationship between absence and emptiness for the mourning process are considered. The author uses the film as a resource throughout.
Topics: Humans; Motion Pictures; Grief; Depressive Disorder; Psychoanalytic Theory; Psychoanalytic Interpretation; Freudian Theory; Psychoanalytic Therapy
PubMed: 38814151
DOI: 10.1080/00332828.2024.2345047 -
La Revue Du Praticien Dec 2019THE TIRED CHILD. Child fatigue is difficult to define and evaluate. This is a common reason for parental concern and consultation. The expressions of fatigue are...
THE TIRED CHILD. Child fatigue is difficult to define and evaluate. This is a common reason for parental concern and consultation. The expressions of fatigue are variable according to age. An organic origin must be sought. It is rarely found when the symptom is isolated. Most often the origin of child and adolescent fatigue is environmental, related to living conditions. The analysis should focus on family constraints, sleep conditions, use of screens, school and activities. A psychological origin must be sought especially a depressive syndrome.
Topics: Adolescent; Child; Depressive Disorder; Family; Fatigue; Humans; Parents; Sleep Wake Disorders
PubMed: 32237587
DOI: No ID Found -
Progress in Brain Research 2023Treatment-resistant depression (TRD) refers to depression that persists even after the patient has undergone adequate trials of two or more antidepressants at...
Treatment-resistant depression (TRD) refers to depression that persists even after the patient has undergone adequate trials of two or more antidepressants at appropriate doses and duration. While there may be controversy around this definition, it reflects the real-world clinical situation where drug therapy is often the primary treatment strategy for major depressive disorder. It's important to note that when a patient is diagnosed with TRD, a comprehensive evaluation of their psychosocial aspects should be carried out. Appropriate psychosocial interventions should also be provided to address the patient's needs. Various psychotherapy models have been proven effective in treating TRD, but not all of them have undergone empirical testing. As a result, some psychotherapy models may be underestimated in treating TRD. Clinicians should consult reference materials and assess the patient's psychosocial aspects to select the most appropriate psychotherapy model for TRD patients. Collaboration with psychologists, social workers, and occupational therapists can also provide valuable input in the decision-making process. This ensures that TRD patients receive comprehensive and effective care.
Topics: Humans; Depressive Disorder, Major; Psychotherapy; Antidepressive Agents; Depressive Disorder, Treatment-Resistant
PubMed: 37414492
DOI: 10.1016/bs.pbr.2023.03.001 -
Annals of Clinical Psychiatry :... Aug 2019An association between cerebrovascular events and psychiatric disorders has been reported. However, the focus has centered on stroke, and there has been a lack of... (Review)
Review
BACKGROUND
An association between cerebrovascular events and psychiatric disorders has been reported. However, the focus has centered on stroke, and there has been a lack of attention to a possible relationship between transient ischemic attacks (TIAs) and depression.
METHODS
We conducted a review of studies that looked specifically at the risk of depression after TIAs and the risk of TIAs in patients with depression. A total of 8 studies were identified, 4 examining the occurrence of depression following a TIA, and 4 examining the occurrence of TIAs after the onset of depression.
RESULTS
There was a bidirectional effect: 3 of 4 studies showed an increased risk of TIAs in patients with depression, and 4 of 4 studies found an increase of depression following a TIA. The percentage of patients having a TIA from the pool of patients with depression was 3.18%. The percentage of patients who developed depression after a TIA in the pooled samples was 6.88%.
CONCLUSIONS
Both depression and TIAs are serious medical disorders and they appear to have a bidirectional relationship. Further clinical and neurobiological studies in this area are warranted.
Topics: Depressive Disorder; Humans; Ischemic Attack, Transient
PubMed: 31046038
DOI: No ID Found -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023Unipolar depression is one of the most significant biomedical problems, which is associated with its high prevalence, a pronounced negative impact on the level of work... (Review)
Review
Unipolar depression is one of the most significant biomedical problems, which is associated with its high prevalence, a pronounced negative impact on the level of work capacity of the population, worsening of the course of most somatic and neurological diseases, and suicide risk. This review presents current data on approaches to the diagnosis of monopolar depression, both classical (clinical and psychometric) and using modern technologies. The existing approaches to the therapy of monopolar depression - psychopharmacologic, psychotherapeutic, and non-drug biological approaches - are discussed. The advantages of the selective serotonin reuptake inhibitor sertraline are presented, and its use as a first-line drug is justified.
Topics: Humans; Depression; Depressive Disorder; Psychometrics; Selective Serotonin Reuptake Inhibitors; Sertraline
PubMed: 37966437
DOI: 10.17116/jnevro202312310133 -
Progress in Brain Research 2023Depression is one of the main public health problems in the world, having a high prevalence and being considered the main cause of disability. An important portion of...
Depression is one of the main public health problems in the world, having a high prevalence and being considered the main cause of disability. An important portion of patients does not respond to treatment with the initial trial of conventional antidepressants in the current depressive episode of moderate to severe intensity, which characterizes treatment-resistant depression. In this context, non-invasive neuromodulation procedures use an electric current or magnetic field to modulate the central nervous system, and they represent a new option for patients with treatment-resistant depression.
Topics: Humans; Transcranial Magnetic Stimulation; Depressive Disorder, Major; Depression; Depressive Disorder, Treatment-Resistant; Brain; Treatment Outcome
PubMed: 37806716
DOI: 10.1016/bs.pbr.2023.03.006 -
NeuroImage. Clinical 2022A significant proportion of patients with major depressive disorder are resistant to antidepressant medication and psychological treatments. A core symptom of...
BACKGROUND
A significant proportion of patients with major depressive disorder are resistant to antidepressant medication and psychological treatments. A core symptom of treatment-resistant depression (TRD) is anhedonia, or the inability to feel pleasure, which has been attributed to disrupted habenula function - a component of the reward network. This study aimed to map detailed neural circuitry architecture related to the habenula to identify neural mechanisms of TRD.
METHODS
35 TRD patients, 35 patients with treatment-sensitive depression (TSD), and 38 healthy controls (HC) underwent resting-state functional magnetic resonance imaging. Functional connectivity analyses were performed using the left and right habenula as seed regions of interest, and the three groups were compared using whole-brain voxel-wise comparisons.
RESULTS
The TRD group demonstrated hyperconnectivity of the left habenula to the left precuneus cortex and the right precentral gyrus, compared to the TSD group, and to the right precuneus cortex, compared to the TSD and HC groups. In contrast, TSD demonstrated hypoconnectivity than HC for both connectivity measures. These connectivity values were significantly higher in patients with a history of suicidal ideation.
CONCLUSIONS
This study provides evidence that, unlike TSD, TRD is characterized by hyperconnectivity of the left habenula particularly with regions of the default mode network. An increased interplay between reward and default mode networks is linked to suicidality and could be a possible mechanism for anhedonia in hard to treat depression.
Topics: Anhedonia; Case-Control Studies; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Habenula; Humans; Magnetic Resonance Imaging; Suicidal Ideation
PubMed: 35305499
DOI: 10.1016/j.nicl.2022.102990 -
BMC Psychiatry Nov 2023Specifiers for a major depressive disorder (MDE) are supposed to reduce diagnostic heterogeneity. However, recent literature challenges the idea that the atypical and...
OBJECTIVES
Specifiers for a major depressive disorder (MDE) are supposed to reduce diagnostic heterogeneity. However, recent literature challenges the idea that the atypical and melancholic specifiers identify more homogenous or coherent subgroups. We introduce the usage of distance metrics to characterize symptom heterogeneity. We attempt to replicate prior findings and explore whether symptom heterogeneity is reduced using specifier subgroups.
METHODS
We used data derived from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC Wave I; N = 5,749) and the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D; N = 2,498). We computed Hamming and Manhattan distances from study participants' unique symptom profiles. Distances were standardized from 0-1 and compared by their within- and between-group similarities to their non-specifier counterparts for the melancholic and atypical specifiers.
RESULTS
There was no evidence of statistically significant differences in heterogeneity for specifier (i.e., melancholic or atypical) vs. non-specifier designations (i.e., non-melancholic vs. non-atypical).
CONCLUSION
Replicating prior work, melancholic and atypical depression specifiers appear to have limited utility in reducing heterogeneity. The current study does not support the claim that specifiers create more coherent subgroups as operationalized by similarity in the number of symptoms and their severity. Distance metrics are useful for quantifying symptom heterogeneity.
Topics: Humans; Depressive Disorder, Major; Depression; Psychopathology; Diagnostic and Statistical Manual of Mental Disorders
PubMed: 38037069
DOI: 10.1186/s12888-023-05377-5