Prediction
of remission from depression by responses on two
items of HAM-D17 rating scale
The
Hamilton Depression (HAM-D) rating scale is
relatively insensitive to improvements in some
depressive symptoms which sometimes falsely
classifies patients as non-responders. Two items
from the HAM-D17 scale, depressed mood (item 1)
and psychic anxiety (item 10) have been
demonstrated to have enhanced sensitivity. These
items were evaluated in a series of studies
comparing the SNRI, venlafaxine and different
selective serotonin reuptake inhibitor, to
determine the degree of prediction of remission
from depression.......... Click
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Cerebral
blood flow remains abnormal in patients
recovered from depression
In
order to examine a possible relationship between
cerebral blood flow changes and recovery from
depression, remitted unipolar depression
patients, individuals currently experiencing a
depressive episode and never-depressed
volunteers were studied before and after
transient sad mood challenge. Positron emission
tomography was used to measure the changes in
regional cerebral blood flow after a temporary
mood provocation of memory-induced sadness
consisting of recalling an extremely sad
personal experience such as
bereavement............ Click
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Benefit
of ethyl-eicosapentaenoate in patients with
persistant depression receiving adequate
therapy
Abnormally
low blood levels of eicosapentaenoate have been
observed in depressed patients. This molecule is
known to be involved in the behaviour of nerve
cells and the deficit could play an important
role in depression. The double-blind trial of 70
patients with refractory depression randomized
to placebo or ethyl-eicosapentaenoate (1, 2, or
4 g per day for 12 weeks) , in addition to their
existing antidepressant treatment was undertaken
to determine the antidepressant activity of
ethyl-eicosapentaenoate in depressed
patients............. Click
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Potentiating
effect of gabapentin in treatment-resistant
depression
Patients
with unipolar recurrent depression
unsuccessfully treated with an SSRI, SNRI, TCA
or MAOI were given gabapentin as add-on therapy
for at least 8 weeks in an open trial. 71%
patients were classed as responders at the end
of the trial. The potentiating effect of
gabapentin was independent of the antidepressant
it was co-administered with.........
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Experience
sampling method (ESM) to assess antidepressant
efficacy
Quality
of life (QoL) is usually measured globally and
retrospectively. A recent study proposed
measuring QoL from moment to moment in daily
life (mQoL) with an experience sampling method
(ESM). In an imipramine v placebo controlled
trial, at 6 weeks, in spite of improvement in
their depression, patients on imipramine had
mQoL values similar to those on placebo.
Similarly those in remission after 18 weeks
still had low level mQoL whereas normal values
had been indicated by classical retrospective
measures........... Click
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Efficacy
of fluvoxamine in prostatodynia
Prostatodynia
is a somatoform pain disorder, with urogenital
pain and urinary symptoms in males. In a
double-blind trial, fluvoxamine was shown to
reduce pain intensity and normalise urinary flow
rates, in comparison with placebo. These effects
were independent of changes in the levels of
depression or anxiety............
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High
risk of suicide in children of suicide
attempters
A
comparison the offspring of two groups of
depressed patients, having previously attempted
suicide and non-attempters, showed that
offspring of parents who had attempted suicide
had a 6-fold greater risk of attempting suicide
compared with offspring of non-attempters.
History of sexual abuse in both parents and
children, offspring substance abuse, mood
disorder, enhanced impulsive aggression and
female gender significantly increased the
risk........ Click
for full article
Paroxetine
inhibits norepinephrine uptake in patients
suffering from major depression
Depressed
patients received paroxetine or desipramine.
Serum from patients on paroxetine inhibited NE
uptake by up to 43% and 5-HT uptake by more than
85% whereas serum from patients on desipramine
produced 85% inhibition of NE uptake and 18%
inhibition of 5-HT uptake.
These
results show that paroxetine is, in fact, a
5-HT/NE uptake inhibitor in vivo although, in
contrast to SNRI antidepressants such as
milnacipran or duloxetine, its effect is not
equal on the two neurotransmitter
systems......... Click
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Antidepressant
discontinuation as a result of ineffective
communication between patient and physician
Depressed
patients and their prescribing physicians
participated in a survey on communication
between doctors and their patients and its
effect on long-term antidepressant therapy.
Nearly three quarters of the physicians reported
asking their patients to continue their
medication for at least 6 months, whereas only a
third of the patients remembered being told this
and more than half reported having received no
instructions at all. The survey showed that
patient misunderstanding of instructions is a
major factor associated with discontinuation of
long-term antidepressant treatment..........
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Association
between physical activity and decreased risk of
depression in the elderly
A
5 year study of nearly 2000 elderly subjects has
shown that greater physical activity, such as
walking, exercising, swimming, or playing active
sports, protects against both the prevalence and
incidence of depression after adjusting for age,
sex, ethnicity, financial strain, chronic
conditions, disability, body mass index, alcohol
consumption, smoking, and social relations.
Exclusion of physically disabled subjects did
not modify the conclusion......Click
for full article.
High
prevalence of obesity in patients with bipolar I
disorder
The
bodyweight of a group of 50 patients with
bipolar disorder was measured during acute
treatment and 12 months of maintenance therapy.
At baseline, 68% of the patients were obese or
overweight. During acute treatment, weight
increase was associated an improvement in
depressive symptoms and a decrease in mania.
Throughout the study there was a negative
relationship between BMI and the tendency to
gain weight......Click
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Induction
of basic fibroblast growth factor in cortex and
hippocampus by antidepressants
Antidepressants
(desipramine, fluoxetine, or mianserin) were
administered acutely and repeatedly (3 weeks) to
rats. After a single injection a short-lasting
increase in basic fibroblast growth factor
(FGF2) mRNA was observed only in the entorhinal
cortex. After three weeks treatment increases in
FGF2 mRNA and FGF2 protein lasting for at least
24 h were seen in the cortex and hippocampus,
brain areas highly implicated in the
pathophysiology of depressive
disorders......Click
for full article
Involvement
of neuronal plasticity in stress and the action
of antidepressants
The
action of most antidepressants resides in
changes of the levels of monoamine
neurotransmitters in the brain. However, there
is increasing evidence that they also modulate
the neurotransmission of glutamate which is the
most abundant neurotransmitter in the brain.
This seems to be specially true in the
hippocampus and other areas of the limbic
system....... Click
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Improved
sleep with nefazodone but not paroxetine in
depressed patients
Sleep
is disturbed in depression and also by
antidepressants such as the selective serotonin
reuptake inhibitors (SSRIs) whereas it seems
that 5-HT2 receptor antagonists
enhance sleep quality. In order to further study
sleep in depression, investigators have compared
the objective and subjective effects of
paroxetine and nefazodone on sleep in patients
suffering from moderate to severe
depression....... Click
for full article
Link
between coil-cortex distance and antidepressant
effect of repetitive transcranial magnetic
stimulation in the elderly
Antidepressant
effects of repetitive transcranial magnetic
stimulation (rTMS) have been shown to be smaller
in older depressed patients than in young
people. A reduction in orbitofrontal cortex
volume has also been demonstrated in geriatric
depressed patients. A recent study set out to
investigate whether a prefrontal atrophy could
be related to the antidepressant response to
rTMS....... Click
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Effect
of placebo-response on brain function
The
clinical response to placebo is important in
depression and very often similar to that
observed with an antidepressant drug. A brain
imaging study has recently investigated
alterations occuring in the brain following
placebo treatment. Positron emission tomography
(PET) was used to measure brain glucose
metabolism in hospitalized men with unipolar
depression enrolled in double-blind trial with
placebo or fluoxetine. The effect of the
administration of placebo or fluoxetine was
evaluated after 6-week of treatment......
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Comparison
of the antidepressant efficacy of the SNRI,
milnacipran, and the SSRI, fluvoxamine, in
patients with major depression.
A
recent Japanese study has compared the
effectiveness of the serotonin and noradrenaline
reuptake inhibitor (SNRI), milnacipran, and the
selective serotonin reuptake inhibitor (SSRI),
fluvoxamine. Nearly 200 outpatients with
major depression according to the DSM-IV were
randomly assigned to receive milnacipran or
fluvoxamine in an open naturalistic trial. There
were significantly more responders with
milnacipran (68.9%) than with fluvoxamine
(46.2%) in severely depressed patients (initial
HDRS score greater than 19
points)......Click
for full article
Link
between hippocampal volume and remission in
geriatic depression
Structural
brain changes occur in depression, particularly
geriatric depression, and they could represent
interesting biological markers of treatment
prognosis. Magnetic magnetic resonance imaging
(MRI) brain scans to determine total cerebral
volume and right and left hippocampal volumes
were carried out at baseline on 60 elderly
depressed patients who were enrolled in a
longitudinal study of antidepressant
efficacy......Click
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Three
mood-stabilizing drugs have a common mode of
action
Patients suffering from bipolar disorder are
often treated with mood-stabilizing drugs such
as lithium, carbamazepine and valproic acid
which are similarly effective. However the
mechanism of action of these structurally
diverse compounds is unknown. A team of
researchers have investigated the effects of
lithium, carbamazepine and valproic acid, at
therapeutic plasma concentrations, on cultured
neurons from newborn rats... Click
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Enhanced
expression of
5-HT2A
receptors
in brains of teenage suicide
victims
5-HT2A
receptor subtypes have recently been studied in
the prefrontal cortex, hippocampus and nucleus
accumbens of post-mortem brains from 15 teenage
suicide victims in comparison with 15 control
matched subjects. Higher binding in the
prefrontal cortex, higher protein expression and
higher mRNA levels were found in the
prefrontal cortex and hippocampus but not in the
nucleus accumbens of the suicide victims...
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for full article
Treatment
of depression during pregnancy by light
therapy
The 5%
of pregnant women who suffer from major
depression cannot be treated by classical
pharmacotherapy during pregnancy due to unknown
possibility of risks for the foetus. Morning
light therapy for 3 to 5 weeks has been shown to
be a potentially interesting clinical
alternative. After 3 weeks of treatment, mean
depression ratings improved by 49%, and by 59%
in the 7 patients who received treatment for 5
weeks. No adverse effects were observed on
pregnancy...Click
for full article
Placebo
trial fails to find efficacy of Hypericum
perforatum (St John's Wort) in major
depression
In
a recent 8 week study comparing the efficacy and
safety of St John's Wort , placebo and the
selective serotonin reuptake inhibitor,
sertraline,neither sertraline nor St John's Wort
were significantly different from placebo in
improving patients' depression as measured by
the Hamilton Depression (HAM-D) Scale. Full
response (remission), occurred in 32% of
placebo-treated patients, 24% with St John's
Wort and 25% with sertraline while partial
response was observed in 11% of patients on
placebo, 14% on St John's Wort and 24% on
sertraline...... Click
for full article
Increased
response of depressed patients to therapy by
switching
antidepressant
A
recent study of 168 patients with long standing
major depression who had failed to respond to
the selective serotonin reuptake inhibitor,
sertraline, or the tricyclic antidepressant,
imipramine were switched to the alternative
medication and their treatment continued
double-blind for a further 12 weeks. Under these
conditions, more than 50% of patients
responded.....Click
for full article
Benefit
of vagus nerve stimulation in major depression
after one year
In
order to verify whether the initial interesting
effects found with vagal nerve stimulation over
3 months were sustained over time and whether
changes in functional status also occured, a 9
month open, naturalistic follow-up study was
undertaken. Thirty adult out-patients with a
non-psychotic major depressive episode and
resistant to classical treatment received an
additional 9 months vagus nerve stimulation
treatment after the end of the 3-month acute
pilot study......Click
for full article
Some
patient categories respond less well to
treatments for depression
Researchers
have studied the response to treatment of 338
primary care patients with dysthymia. In a
randomised controlled 11-week trial the patients
were treated with paroxetine, problem-solving
psychotherapy or placebo. At the end of the
study, 52% of all patients had recovered.
However in some patient categories, such as
elderly (> 60 years) women, people with lower
educational levels, with more severe medical
(non-psychiatric) illness, or with higher scores
on the neuroticism dimension of personality,
recovery rates were lower......Click
for full article
Antidepressants
cause increased neurogenesis in rat
hippocampus
Stress
and glucocorticoid activation provoke atrophy of
dendritic arborisation and reduced formation of
new neurones in the mammalian brain. The
consequence is a reduced volume of the
hippocampus in depressive disorders. In
contrast, stimuli such as exercise, hippocampus
dependent memory formation and learning
opportunities, estrogen and enhanced social
interaction increase neurogenesis. Studies have
demonstrated that administration of
antidepressants for 2 to 4 weeks enhances
neurogenesis.....Click
for full article
Improvement
of recurrent major depression by omega-3 fatty
acid as an adjunct to treatment
Epidemiological
evidence suggests that countries which consume
high proportions of fish oil show low rates of
depressive disorder. Some investigators have
studied the omega-3 fatty acid ester of
eicosapentaenoic acid (E-EPA) as an addition to
classical antidepressant medication treatment of
patients with recurrent unipolar depression.
Twenty patients (17 women and 3 men of 53 years
age) were enrolled in a 4-week, parallel-group,
double-blind study .....Click
for full article
Link
between exercise, mood and phenylethylamine
levels
Regular
exercise is known to boost mood and may avoid
the occurence of depression. It is reported that
levels of phenylethylamine in the body are
elevated by aerobic activity, and that this may
explain the relationship. A group of
investigators have noticed that the mean urine
concentration of phenylethylamine in 20 healthy
young men increased by 77% after they ran for 30
minutes on a treadmill...... Click
for full text
Possible
mediation of seasonal affective disorder by
hypothalamus neuronal signals
Melatonin
is secreted by neurons in the suprachiasmatic
nucleus of the hypothalamus. A study compared 55
patients with seasonal affective disorder (SAD)
and 55 matched healthy control subjects. Plasma
levels of melatonin in each subject were
measured every 30 minutes for 24 hours, once in
the winter and once in the summer. During the
periods of measurement the light condition was
maintained at < 1 lux. In patients with
SAD.....Click
for full text
Association
between birth weight and late life
depression
A
low weight at birth is a risk factor for heart
disease, hypertension, diabetes and stroke.
There is an association between depression and
these diseases. A study examined the link
between low birth weight and depression. Birth
records of 882 male individuals born at
full-term in the 1920s were consulted and their
weight at birth and at age of 1 year noted. At
68 years old, study volunteers completed the
Geriatric Depression Scale.....Click
for full text