Current Treatments For Depression Research Articles

Prevalence, treatment and correlates of depression in multiple sclerosis

BackgroundThe prevalence of depression in Multiple Sclerosis (MS) is often assessed by administering patient reported outcome measures (PROMs) examining depressive symptomatology to population cohorts; a recent review summarised 12 such studies, eight of which used the Hospital Anxiety and Depression Scale-Depression (HADS-D). In clinical practice, depression is diagnosed by an individual structured clinical interview; diagnosis often leads to treatment options including antidepressant medication. It follows that an MS population will include those whose current depressive symptoms meet threshold for depression diagnosis, plus those who previously met diagnostic criteria for depression and have been treated such that depressive symptoms have improved below that threshold. We examined a large MS population to establish a multi-attribute estimate of depression, taking into account probable depression on HADS-D, as well as anti-depressant medication use and co-morbidity data reporting current treatment for depression. We then studied associations with demographic and health status measures and the trajectories of depressive symptoms over time. MethodsParticipants were recruited into the UK-wide Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) study, with demographic and disease data from clinical records, PROMs collected at intervals of at least 9 months, as well as co-morbidities and medication. Interval level conversions of PROM data followed Rasch analysis. Logistic regression examined associations of demographic characteristics and symptoms with depression. Finally, a group-based trajectory model was applied to those with depression. ResultsBaseline data in 5633 participants showed the prevalence of depression to be 25.3 % (CI: 24.2–26.5). There were significant differences in prevalence by MS subtype: relapsing 23.2 % (CI: 21.8- 24.5), primary progressive 25.8 % (CI: 22.5–29.3), secondary progressive 31.5 % (CI: 29.0–34.0); disability: EDSS 0–4 19.2 % (CI: 17.8–20.6), EDSS ≥4.5 31.9 % (CI: 30.2–33.6); and age: 42–57 years 27.7 % (CI: 26.0–29.3), above or below this range 23.1 % (CI: 21.6–24.7). Fatigue, disability, self-efficacy and self esteem correlated with depression with a large effect size (>0.8) whereas sleep, spasticity pain, vision and bladder had an effect size >0.5. The logistic regression model (N = 4938) correctly classified 80 % with 93 % specificity: risk of depression was increased with disability, fatigue, anxiety, more comorbidities or current smoking. Higher self-efficacy or self esteem and marriage reduced depression. Trajectory analysis of depressive symptoms over 40 months in those with depression (N = 1096) showed three groups: 19.1 % with low symptoms, 49.2 % with greater symptoms between the threshold of possible and probable depression, and 31.7 % with high depressive symptoms. 29.9 % (CI: 27.6–32.3) of depressed subjects were untreated, conversely of those treated, 26.1 % still had a symptom level consistent with a probable case (CI: 23.5–28.9). ConclusionA multi-attribute estimate of depression in MS is essential because using only screening questionnaires, diagnoses or antidepressant medication all under-estimate the true prevalence.Depression affects 25.3 % of those with MS, almost half of those with depression were either untreated or still had symptoms indicating probable depression despite treatment. Services for depression in MS must be pro-active and flexible, recognising the heterogeneity of outcomes and reaching out to those with ongoing symptoms.

Acupuncture Ameliorates Depression-Like Behaviors Through Modulating the Neuroinflammation Mediated by TLR4 Signaling Pathway in Rats Exposed to Chronic Restraint Stress

Recently, emerging evidence has identified that stress-induced activation of neuroinflammation is considered to be one of the most prevalently precipitating factors in the pathogenesis of depression. Data from clinical trials and experimental findings has verified the efficacy and safety of acupuncture in the prevention and treatment of depression. However, the mechanism of the preventive effect of acupuncture for depression has not been fully elucidated. The current study aimed to investigate the preventive effect and mechanism of acupuncture through modulating the neuroinflammation mediated by toll-like receptor 4 (TLR4) signaling pathway in rats exposed to chronic restraint stress (CRS). All rats were subjected to CRS for 21 days, with the exception of rats in control group. One hour before CRS, rats in acupuncture group were exposed to acupuncture at Baihui (GV20) and Yintang (GV29). The depression-like behaviors were evaluated by body weight assessment and sucrose preference test at 0, 7, 14, and 21 days. The expression of activated microglia in hippocampus was detected by immunofluorescence. The expression of key proteins on TLR4 signaling pathway of TLR4, MyD88, TRAF6, NF-κB p65, TNF-α, and mRNA of TLR4 in the hippocampus was detected by western blot and real-time quantitative polymerase chain reaction to investigate the effect of acupuncture on stress-induced activation of neuroinflammation. The present study provided evidence that acupuncture exerted potential preventive effect that might be mediated in part by suppressing the neuroinflammation induced by TLR4 signaling pathway, which may be a promising treatment target to improve current treatments for depression.

Current Treatment of Depression in Children with Autism and Intellectual and Developmental Disabilities

Current Treatment of Depression in Children with Autism and Intellectual and Developmental Disabilities

Intranasal Administration of Brain-Derived Neurotrophic Factor Rescues Depressive-Like Phenotypes in Chronic Unpredictable Mild Stress Mice.

IntroductionMajor depression disorder is the most common diagnosed mental illnesses, and it bring a high social and economic burden. However, the current treatment for depression has limitations with side effects. Hence, there is an urgent need to search more effective treatment for major depressive disorder. Brain-derived neurotrophic factor (BDNF) is a neurotrophin that is vital to the survival, growth, and maintenance of neurons.MethodsWe administered BDNF into chronic unpredictable mild stress (CUMS)-induced depression mice and assessed the effects of intranasal delivery of BDNF in depression by the tail suspension test, forced swimming test, novelty suppressed feeding test, and open-field test.ResultsWe find that the intranasal administration of BDNF reversed the depressive-like behaviors in CUMS mice as measured Further analyses suggested that BDNF treatment reduced pro-inflammatory cytokine (IL-6, TNF-α, iNOS and IL-1β) expressions in the hippocampus of CUMS mice. In addition, our results showed that BDNF markedly reduced oxidative stress in the hippocampus and blood of CUMS mice. Moreover, our data suggested that BDNF treatment increased neurogenesis in the hippocampus of CUMS mice.DiscussionTaken together, our results for the first time demonstrated that intranasal delivery of BDNF protein exhibited anti-depressant-like effects in mice, and therefore may represent a new therapeutic strategy for major depressive disorder.

The molecular pathophysiology of depression and the new therapeutics.

Major depressive disorder (MDD) is a highly prevalent and disabling disorder. Despite the many hypotheses proposed to understand the molecular pathophysiology of depression, it is still unclear. Current treatments for depression are inadequate for many individuals, because of limited effectiveness, delayed efficacy (usually two weeks), and side effects. Consequently, novel drugs with increased speed of action and effectiveness are required. Ketamine has shown to have rapid, reliable, and long‐lasting antidepressant effects in treatment‐resistant MDD patients and represent a breakthrough therapy for patients with MDD; however, concerns regarding its efficacy, potential misuse, and side effects remain. In this review, we aimed to summarize molecular mechanisms and pharmacological treatments for depression. We focused on the fast antidepressant treatment and clarified the safety, tolerability, and efficacy of ketamine and its metabolites for the MDD treatment, along with a review of the potential pharmacological mechanisms, research challenges, and future clinical prospects.

A collaborative, computer-assisted, psychoeducational intervention for depressed patients with chronic disease at primary care: protocol for a cluster-randomized controlled trial

IntroductionDepression treatment recommendations seldom include chronic illness comorbidity.ObjectivesTo describe the rationale and methods for a cluster-randomized trial (CRT) in primary care clinics (PCC) comparing a computer-assisted psychoeducational (CAPE) intervention to usual care (UC) for depressed patients with hypertension or diabetes.MethodsTwo-arm, single-blind CRT in Santiago, Chile. Eight PCC will be randomly assigned to the intervention or UC. A total of 360 depressed individuals aged 18 or older PHQ-9 scores ≥ 15 and hypertension or diabetes will be recruited. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and residents in long-term care facilities will be excluded. Patients in the intervention will receive eight CAPE sessions by trained therapists, structured telephone calls to track progress, and usual medical care for chronic diseases. Psychologists and psychiatrists will regularly supervise therapists. To ensure continuity of care, the PCC team will meet monthly with a research team member. Patients in UC will receive standard medical and depression treatment. Three, six, and twelve months after enrollment, outcomes will be assessed. The primary outcome will be a 50% reduction in baseline PHQ-9 scores at six months. Intention-to-treat analyses will be used.ResultsA previous, small-scale pilot study provided valuable insights for study design.ConclusionsThis study will provide first-hand evidence on the effectiveness of a CAPE for depressed patients with chronic diseases at PCC in a Latin American country.DisclosureNo significant relationships.

Childhood maltreatment and inflammation: Leveraging structural equation modeling to test the social signal transduction theory of depression

BackgroundThe experience of childhood maltreatment has long been understood to increase the risk for experiencing depressive symptoms and is often associated with an overall worse course of illness when these symptoms are elevated to a major depressive episode. Despite this, current treatments for depression continue to require a need for a greater understanding of the underlying mechanisms. MethodWe utilized structural equation modeling to test the effects of childhood maltreatment on inflammation and depressive symptoms. Inflammation was conceptualized as a latent variable, estimated by CRP, fibrinogen, IL-6, sICAM-1, sE-selectin, and TNF- α; whereas depressive symptoms were estimated using the subscales for the Center for Epidemiological Studies-Depression scale and childhood maltreatment was estimated using the subscales for the Childhood Trauma Questionnaire. ResultsMultivariate results identified that childhood maltreatment had a significant positive relationship with inflammation as well as depressive symptoms, and inflammation had a significant positive relationship with depressive symptoms. Notably, childhood maltreatment also had a significant positive relationship with perceived stress over the last month and this perceived stress had a positive relationship with depressive symptoms; however perceived stress had no relationship with inflammation. LimitationsData from the present study is cross-sectional, requiring replication with longitudinal data. Some measures such as childhood maltreatment were measured by self-report and should be replicated with verified reports. ConclusionsThese results provide support for the Social Signal Transduction Theory of Depression, emphasizing the importance of the immune system and inflammation as a relevant mediator between early social treats and adulthood depressive symptoms.

Older adults' willingness to take magnesium to treat depression.

Depression affects up to 15% of community-dwelling older adults. Late-life depression is frequently underdiagnosed and undertreated. When depression in older adults is identified, up to 80% of treatment occurs in primary care. Currently available treatments have significant limitations (e.g., modest effectiveness, high costs, adverse effects, poor adherence, and social stigma), therefore additional treatment options are essential. Over the counter magnesium chloride is inexpensive, widely available, generally safe, well-absorbed, and was efficacious in prior studies, often within 2 weeks. To collect background information on magnesium supplement use and acceptability in older adults with a depression. Online survey. National sample. Adults 65 and older living in the United States currently experiencing symptoms of depression based on Patient Health Questionnaire (PHQ- 2) results. The primary outcome was willingness to take magnesium supplements instead of prescription medication for the treatment of depression. Secondary measures included current supplement use, comfort level with taking magnesium to treat depression, and whether they think magnesium would help improve symptoms of depression. Of 153 respondents, 97 (63%) were female, 143 (93%) identified as white, and 130 (85%) were between the ages 65 and 75 years. 112 (73%) took a supplement daily, including 15 (10%) taking magnesium. 50 (33%) were currently being treated for depression. On a 4-point Likert scale ranging from "Strongly Agree" to "Strongly Disagree," 83% of respondents "Agreed" or "Strongly Agreed" in terms of their willingness to take magnesium instead of a prescription medication. A majority also "Agreed" or "Strongly Agreed" that they were willing (89%) and comfortable (89%) with taking magnesium to treat depression and also that it would improve symptoms of depression (73%). Women were more likely to agree with these statements (p<0.05), but there were no differences based on age or current treatment for depression. A majority of older community-dwelling adults are willing to take magnesium for the treatment of depression. Many adults are already taking at least 1 over the counter supplement daily. Further research is needed to determine the efficacy of magnesium supplements as an alternative treatment option in this population.

Are we overlooking the obvious? Addressing social determinants of health that contribute to perinatal depression.

Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

Hippocampal BMP signaling as a common pathway for antidepressant action.

The benefits of current treatments for depression are limited by low response rates, delayed therapeutic effects, and multiple side effects. Antidepressants affect a variety of neurotransmitter systems in different areas of the brain, and the mechanisms underlying their convergent effects on behavior have been unclear. Here we identify hippocampal bone morphogenetic protein (BMP) signaling as a common downstream pathway that mediates the behavioral effects of five different antidepressant classes (fluoxetine, bupropion, duloxetine, vilazodone, trazodone) and of electroconvulsive therapy. All of these therapies decrease BMP signaling and enhance neurogenesis in the hippocampus. Preventing the decrease in BMP signaling blocks the effect of antidepressant treatment on behavioral phenotypes. Further, inhibition of BMP signaling in hippocampal newborn neurons is sufficient to produce an antidepressant effect, while chemogenetic silencing of newborn neurons prevents the antidepressant effect. Thus, inhibition of hippocampal BMP signaling is both necessary and sufficient to mediate the effects of multiple classes of antidepressants.

Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial.

Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT. We conducted a randomized, controlled, assessor-blinded non-inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79). Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ-9) at the beginning and end of the treatment phase as well as one year after the end of treatment. In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT -8.06, 95% CI [-10.85, -5.27], p < .001; CBT -5.99, 95% CI [-8.55, -3.44], p < .001). The non-inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15). Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression. Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body-related interventions are still underrepresented in current treatments for depression. Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall. The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT). Additionally the 10-weeks BPT-programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health-related quality of life, coping, body image, self-efficacy, and global self-esteem.

3D-ALMOND-QSAR Models to Predict the Antidepressant Effect of Some Natural Compounds.

The current treatment of depression involves antidepressant synthetic drugs that have a variety of side effects. In searching for alternatives, natural compounds could represent a solution, as many studies reported that such compounds modulate the nervous system and exhibit antidepressant effects. We used bioinformatics methods to predict the antidepressant effect of ten natural compounds with neuroleptic activity, reported in the literature. For all compounds we computed their drug-likeness, absorption, distribution, metabolism, excretion (ADME), and toxicity profiles. Their antidepressant and neuroleptic activities were predicted by 3D-ALMOND-QSAR models built by considering three important targets, namely serotonin transporter (SERT), 5-hydroxytryptamine receptor 1A (5-HT1A), and dopamine D2 receptor. For our QSAR models we have used the following molecular descriptors: hydrophobicity, electrostatic, and hydrogen bond donor/acceptor. Our results showed that all compounds present drug-likeness features as well as promising ADME features and no toxicity. Most compounds appear to modulate SERT, and fewer appear as ligands for 5-HT1A and D2 receptors. From our prediction, linalyl acetate appears as the only ligand for all three targets, neryl acetate appears as a ligand for SERT and D2 receptors, while 1,8-cineole appears as a ligand for 5-HT1A and D2 receptors.

A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial

BackgroundDepression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile.MethodsTwo-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed.DiscussionThis study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country.Trial registrationretrospectively registered in ClinicalTrials.gov, first posted: November 3, 2020, under identifier: NCT04613076.

Brain proteome-wide association study implicates novel proteins in depression pathogenesis.

Depression is a common condition but current treatments for depression are only effective in a subset of individuals. To identify novel treatment targets, we integrated depression GWAS results (N=500,199) with human brain proteomes (N=376) to perform a proteome-wide association study (PWAS) of depression, followed by Mendelian randomization. We identified 19 genes consistent with being causal in depression, acting via their cis-regulated brain protein abundance. We replicated 9 of these genes using an independent depression GWAS (N=307,353) and human brain proteomic dataset (N=152). Eleven of these 19 genes also had their cis-regulated mRNA levels associated with depression based on integration of the depression GWAS with human brain transcriptomes (N=888). Meta-analysis of the discovery and replication PWAS identified 25 brain proteins consistent with being causal in depression, and 20 were not previously implicated in depression by GWAS. Together, these findings provide novel promising brain protein targets for further mechanistic and therapeutic studies.

Diagnosis, Mechanism, and Current Treatment of Depression: Current Situation and Future Directions

Diagnosis, Mechanism, and Current Treatment of Depression: Current Situation and Future Directions

Patient-reported outcome measures for monitoring primary care patients with depression (PROMDEP): study protocol for a randomised controlled trial

BackgroundBenefits to patients from reduced depression have been shown from monitoring progress with patient-reported outcome measures (PROMs) in psychological therapy and mental health settings. This approach has not yet been researched in the United Kingdom for primary care, which is where most people with depression are treated in the United Kingdom.MethodsThis is a parallel-group cluster randomised trial with 1:1 allocation to intervention and control. Patients who are age 18+ years, with a new episode of depressive disorder/symptoms, meet the inclusion criteria. Patients with current depression treatment, comorbid dementia/psychosis/substance misuse/suicidal ideas are excluded. The intervention includes the Administration of Patient Health Questionnaire (PHQ-9) as a PROM within 2 weeks of diagnosis and at follow-up 4 weeks later. General practitioners are trained in interpreting scores and asked to take them into account in their treatment decisions. Patients are given written feedback on scores and suggested treatments. The primary outcome measure is Depression on the Beck Depression Inventory BDI-II at 12 weeks. Secondary outcomes include BDI-II at 26 weeks, changes in drug treatments and referrals, social functioning (Work & Social Adjustment Scale) and quality of life (EQ-5D) at 12 and 26 weeks, service use over 26 weeks (modified Client Services Receipt Inventory) to calculate NHS costs, and patient satisfaction at 26 weeks (Medical Informant Satisfaction Scale). The sample includes 676 total participants from 113 practices across three centres. Randomisation is achieved by computerised sequence generation. Blinding is impossible given the nature of the intervention (self-report outcome measures prevent rating bias). Differences at 12 and 26 weeks between intervention and controls in depression, social functioning and quality of life are analysed using linear mixed models, adjusted for socio-demographics, baseline depression, anxiety, and clustering, while including practice as a random effect. Patient satisfaction, quality of life (QALYs) and costs over 26 weeks will be compared between arms. Qualitative process analysis includes interviews with 15–20 GP/NPs and 15–20 patients per arm to reflect trial results and implementation issues, using Normalization Process Theory as a theoretical framework.DiscussionIf PROMs are helpful in improving patient outcomes for depression even to a small extent, then they are likely to be good value for money, given their low cost. The benefits could be considerable, given that depression is common, disabling, and costly.Trial registrationISRCTN no: 17299295. Registered 1st October 2018.

Estimated Cardiorespiratory Fitness Is Associated With Reported Depression in College Students.

Depression is a serious but treatable health issue that affects college students at an alarming rate. Improved cardiorespiratory fitness (CRF) decreases depression risk and severity but this relationship has not been fully evaluated in the college student population. Non-exercise estimated CRF (eCRF) could be used to identify students at risk for or suffering from depression. This study investigated the associations of depression and eCRF in college students. Participants (N = 437) completed a survey which included demographic and student-status questions, eCRF variables, and a validated depression instrument. Descriptive, chi-square, t-test, regression, and odds ratio analyses were employed. Depression was associated with low-fitness (X2 = 4.660, P = 0.031) and eCRF below age-predicted CRF (t = 3.28, P < 0.001). Predictors of increased depression included low-fitness, sexual orientation, current depression treatment, and GPA (R2 = 0.145–0.159; Adj R2 = 0.135–0.149). Odd ratio analyses determined that low-fitness increased the risk of reporting depression (β = 2.39, P = 0.017, 95% CI = 1.17–4.872) which remained significant when adjusted (β = 2.478, P = 0.017, 95% CI = 1.175–5.229). Adjusted odds ratio analyses also indicated increased risk of reporting depression for those in a sexual minority (β = 2.582, P = 0.001, 95% CI = 1.44,4.629) and undergoing current depression treatment (β = 2.393, P < 0.001, 95% CI = 2.393–13.043). High levels of fitness did not reduce the odds of reporting depression compared to age predicted CRF. A simple eCRF algorithm can be used to identify college student depression.

Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries

Physical injury is associated with postinjury mental health problems, which typically increase disability, cost, recidivism, and self-medication for symptoms. To determine risk and protective factors across the life span that contribute to depression and posttraumatic stress symptom severity at 3 months after hospital discharge. This prospective cohort study used a 3-month postdischarge follow-up of patients who had been treated at an urban, level 1 trauma center in the Northeastern United States. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia, Pennsylvania, region were eligible and consecutively enrolled. Those who were experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving current treatment for depression or posttraumatic stress disorder (PTSD) were excluded. Data were collected from January 2013 to October 2017. Data analysis took place from January 2018 to August 2018. A serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent, and acute stress responses. Depression and PTSD symptom severity were assessed with the Quick Inventory of Depressive Symptoms-Self-report and the PTSD Check List-5. The a priori hypothesis was that risk and protective factors are associated with depression and PTSD symptom severity. The analytic approach was structural equation modeling. A total of 623 black men were enrolled. Of these, 502 participants (80.6%) were retained at 3-month follow-up. Their mean (SD) age was 35.6 (14.9) years; 346 (55.5%) had experienced intentional injuries, and the median (range) Injury Severity Score was 9 (1-45). Of the 500 participants with complete primary outcome data, 225 (45.0%) met the cut point criteria for mental health diagnoses at 3 months. For both mental health outcomes, the models fit the data well (depression: root mean square error of approximation [RMSEA], 0.044; comparative fit index [CFI], 0.93; PTSD: RMSEA = 0.045; CFI = 0.93), and all hypothesized paths were significant and in the hypothesized direction. Outcomes were associated with poor preinjury health (standardized weights: depression, 0.28; P < .001; PTSD, 0.17; P = .02), acute psychological reactions (depression, 0.34; PTSD, 0.38; both P < .001), and intentional injury (depression, 0.16; PTSD, 0.24; both P < .001). Acute psychological reactions were associated with childhood adversity (depression, 0.33; PTSD, 0.36; both P < .001). A history of prior mental health challenges (depression, 0.70; PTSD, 0.70; both P < .001) and psychological or emotional health resources (depression, -0.22; PTSD, -0.23; both P = .003) affected poor preinjury health, which was in turn associated with acute psychological reaction (depression, 0.44; PTSD, 0.42; both P < .001). The intersection of prior trauma and adversity, prior exposure to neighborhood disadvantage, and poorer preinjury health and functioning are important, even in the midst of acute medical care for traumatic injury. These results support the importance of trauma-informed health care and focused assessment to identified patients with injuries who are at highest risk for poor postinjury mental health outcomes.

Cordyceps sinensis combined with duloxetine improves sleep symptoms in patients with depression: a randomized, double-blind, placebo-controlled study

Background and objectives: Patients with depression can experience sleep disorder. Current treatments for depression, such as duloxetine and selective serotonin reuptake inhibitors, not only have a slow onset of action but also are associated with side effects such as dizziness, blurred vision, and ataxia. The main active ingredient of cordyceps sinensis, cordycepin, may have antidepressant effects, as well as pro-immunity, anti-inflammatory, anti-tumor, anti-fatigue, and anti-viral properties. In this randomized controlled trial, we investigate the safety and effectiveness of cordyceps sinensis (containing approximately 1.0% cordycepin) in combination with duloxetine in treating sleep disorder in patients with depression. Methods: In this randomized, double-blind, placebo-controlled, prospective trial, we plan to include 286 patients with depression receiving treatment at Beijing Anding Hospital of Capital Medical University, China. These patients are randomly assigned to undergo cordyceps sinensis combined with duloxetine or placebo combined with duloxetine. Duloxetine is assigned in an open manner, while cordyceps sinensis and placebo are assigned in a double-blind manner. Participants or their legal guardians are informed of the study protocol and medication and sign informed consent. A total of 246 patients were included in the polit study. Results: The primary outcome measure is the proportion of patients with ≥ 50% difference in 17-item-Hamilton Depression Rating Scale total score after 6 weeks of treatment relative to baseline. The secondary outcome measures are complete remission rate after 6 weeks of treatment; effectiveness rate after 1, 2, and 4 weeks of treatment; changes in Athens Insomnia Scale score, 17-item-Hamilton Depression Rating Scale total score, Arizona Sexual Experience Scale score, Mini-International Neuropsychiatric Interview suicide score, Digit Symbol Substitution Test score, Perceived Deficits Questionnaire-Depression score, 16-item Quick Inventory of Depressive Symptomatology Self-Report Scale score, 7-item Generalized Anxiety Disorder Scale score, and Sheehan Disability Scale score after 1, 2, 4, and 6 weeks of treatment relative to baseline; changes in Insight and Treatment Attitude Questionnaire score, and time and proportion of sleep drug use during the study period after 6 weeks of treatment relative to baseline; electroencephalogram results after 2 and 6 weeks of treatment; and blood biomarkers, safety indicators, and adverse events after 6 weeks of treatment. Results of a pilot study (during 2012–2016) involving 246 patients with depression receiving duloxetine 60 mg/d or fluoxetine 20 mg/d revealed that there was a similar percentage difference in 17-item-Hamilton Depression Rating Scale total score after 6 weeks of treatment relative to baseline and a similar incidence of drug use-related adverse events for both treatments. Discussion: We plan to perform a future study involving 286 patients to validate that cordyceps sinensis combined with duloxetine can effectively improve sleep symptoms of depression. The trial will provide data to support the clinical application of cordyceps sinensis. Ethics and registration: This study was approved by Hospital Ethics Committee, Beijing Anding Hospital of Capital Medical University, China (approval No. 2017-79-2017111-2) on December 20, 2017. This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-INR-17014074). Protocol version: 3.0.

Clinic-based Depression Screening in Gynaecologic Oncology Patients Using the Patient Health Questionnaires-2 (PHQ-2): Are we Identifying the Highest Risk Patients at their Initial Visit?

Objectives: The 2-item Patient Health Questionnaire (PHQ-2) is a short self-reported questionnaire used to screen for depression. Currently, no studies have evaluated the use of this tool among gynecology oncology patients. The objective of this study was to evaluate the sensitivity of the PHQ-2 in a gynaecologic oncology patient population compared with patient reported symptoms, medical history, and treatment for depression. Risk factors for depressive symptoms and treatment effect of antidepressants were also evaluated.Methods: Consecutive 12-month new patient visits attending a gynaecologic oncology clinic completed the PHQ-2 and written intake form. Each new patient was verbally administered the PHQ-2, and then administered a written health questionnaire which gathers information about current symptoms of depression (ROS, within the past week), current diagnosis of depression, and medications with a treatment indication of depression. Additional clinical data was abstracted from patient charts and entered into a database.Results: A total of 439 patients completed the PHQ-2 and written intake form. The average age was 53 years old (SD=15). The majority were White (67%), primarily spoke English (92%) and 54% did not have current diagnosis of cancer at their initial visit. Sixty-one patients screened positive on the PHQ-2, while 121 had a positive history, 92 had positive review of systems, and 79 indicated medications prescribed for depression. The sensitivity of the PHQ-2 for identifying patients meeting any criteria for depression on the written questionnaire was 18.7% with a specificity of 87.9%. The sensitivity and specificity of the PHQ-2 to identify patients reporting a current diagnosis of depression was 56.3% and 97.4% respectively, 28.8% and 89.5% respectively for the intake form, and 20.4% and 87.8% for patients on medications. Among the variables, pain correlated positively to PHQ-2 (r=0.13, p<.01), and those with a diagnosis of depression (r=0.22, p<.01). Menopause had a positive association (r=.13, p<.01) in women who scored positive on the PHQ-2. Hysterectomy, oophorectomy, current administration of chemotherapy, hormone replacement therapy did not significantly alter rates of depression.Conclusion: Depression is prevalent in the gynaecologic oncology clinic population, with forty-six percent of all new patients reporting depressive symptoms, diagnosis of depression and/or current treatment for depression. PHQ- 2 demonstrated good psychometric properties when screening for depressive symptoms in Gynaecologic oncology patients. Learning Objectives: Learners will be able to identify risk factors for patients at risk of depression utilizing PHQ-2 in a gynaecologic oncology population.