Diagnosis Of Recurrent Depressive Disorder Research Articles

Cost Analysis for Inpatient Treatment of Recurrent Depressive Disorder in Russia

ObjectivesTo estimate costs of pharmacotherapy of recurrent depressive disorder (RDD) in a hospital-based care. MethodsIn the study, we analyzed the real-world practice in hospital-based care and the costs of RDD pharmacotherapy. A total of 119 case histories of patients who received a diagnosis of RDD and were hospitalized in 2017 were retrospectively analyzed. The study examined sociodemographic data, clinical and economic data, the frequency of prescribing medications, and medical expenses per 1 hospitalization and per day. The sample (N = 119) was divided into 3 groups according to the International Classification of Diseases-10th Revision code and the severity of the disease. The cost conversion factor was 1 euro equals 89.92 rubles. ResultsAntidepressants and antipsychotic drugs prevailed in the structure of prescriptions (32% and 36%, respectively). Antidepressants had the largest share in the total cost structure (about 41%), while the total cost of antidepressants and antipsychotics reached a total of 70%. Less than half of the costs were drugs included in the Russian RDD hospital treatment standard. The most expensive group in terms of pharmacotherapy costs per patient was the group “patients with RDD of moderate severity” (F33.1)—€61.1 ± 92.0 per case of hospitalization; this diagnosis was made in 80% of hospitalized patients. ConclusionsAssessment of real-world practices and costs of treatment of patients with RDD allows for more widespread implementation of management methods that allow making a choice in favor of more cost-effective drugs for the treatment of RDDs in Russia.

A description of the use of zuclopenthixol decanoate long-acting injection in a large mental health trust

AimsAdherence with antipsychotic medication is an important factor in the prevention of relapse in psychotic disorders such as schizophrenia. Long acting antipsychotic injections promote improved adherence. In recent years, second generation antipsychotic long-acting injections have become increasingly popular, and little has been written about the use of the older depot medications. Here, we explore the current use of one of the first-generation antipsychotic long acting injections in Birmingham and Solihull Mental Health NHS Foundation Trust.MethodAn 18-month retrospective case-note review of all patients who started zuclopenthixol decanoate during the first 6 months of 2018 (n = 45)ResultKey findings included: - ⋅71% were male⋅The mean age was 37 (range 19-65)⋅The most common diagnoses were: schizophrenia (51%), bipolar affective disorder (18%) and schizoaffective disorder (13%). We noted that 2 individuals (4%) had a primary diagnosis of recurrent depressive disorder, 2 (4%) had a primary diagnosis of emotionally unstable personality disorder.⋅60% of those who were prescribed zuclopenthixol decanoate discontinued it within the 18-month follow-up period.⋅The vast majority of discontinuation occurred within the first 6 months, and after this, few individuals stopped treatment.⋅The most common reason for discontinuation was side effects (57%), with other reasons including patient choice (7%), non-compliance (7%), pregnancy (4%), or needle phobia (4%).ConclusionZuclopenthixol decanoate has been used for individuals with both schizophrenia and paranoid psychosis (where it is licenced) and also occasionally for other indications. A high proportion discontinued the zuclopenthixol within 6 months, this generally being attributed to adverse effects. Those who were still receiving this medication at 6 months were very likely to continue to take it throughout the 18 months. We would therefore recommend robust monitoring for and management of adverse effects in the early phases of treatment.

Mindfulness based cognitive therapy for recurrent depressive disorder

AimsMindfulness-based therapies have been demonstrated to be effective in reducing anxiety, stress and depressive symptoms in adults. Depression is a chronic relapsing condition. Major depressive disorder is one of the most common causes of ill health and functional impairment.Our goal was to assess the real world clinical effectiveness of Mindfulness Based Cognitive Therapy (MBCT) for Recurrent Depressive Disorder in three domains:-Depression, anxiety and stress levels-Mindfulness level-Self-compassion levelMethodPatients with a diagnosis of Recurrent Depressive Disorder (primary or secondary diagnosis) were referred by their community mental health team to participate in an 8-week educational MBCT programme. Participants completed the Depression, Anxiety and Stress (DASS), 5-Facet Mindfulness and Self Compassion self-rated scales prior to commencing and at the end of the course. They were also invited to give qualitative feedback at the end of the course.Data were collected from four groups who completed the course over a period of twelve months. A paired samples test was used to compare pre and post intervention scores to determine effect size.ResultWe had complete data for 19 participants out of a cohort of 34. Pre intervention scores were similar for both groups.The mean age of the cohort was 47 years (SD of 10 years), 3 male, 16 female.Patients showed a clinically significant reduction of symptoms in depression, anxiety and stress, with respective reductions of 48%, 26% and 43% post intervention. Results were statistically significant for depressaion and stress p <0.001 but not for anxiety p = 0.130.Positive trends were seen in all domains of the 5-Fact Mindfulness and Self Compassions scales, with mean improvements of 28.2% and 35.3% respectively. All results were statistically significant.We also collected anonymized qualitative feedback which highlighted themes of empowerment, skill acquisition and improved coping.ConclusionNumerous studies have demonstrated poor compliance with antidepressant treatments commonly prescribed in Recurrent Depressive Disorder. This small scale study demonstrates a statistical and clinical benefit of MBCT for these patients, supporting greater use of such novel non-pharmacological therapeutic options as treatment strategies..

Validation of the Russian version of the hypomania checklist (HCL-33) for the detection of bipolar disorder in patients with a current diagnosis of recurrent depression

• In Russia bipolar disorder misdiagnosed as depression in 30–40% of patients. • New 33-item hypomania self-report (HCL-33) screens for past hypomanic episodes. • Russian HCL-33 effectively detects bipolar disorder in patients with depression. • Short 6-item version of the HCL proposed with good specificity and sensitivity. • Limitations: specific sample and no comparisons with other self-report instruments. Bipolar disorder (BD), particularly BD-II, is frequently misdiagnosed as recurrent depressive disorder (RDD) because past hypomanic episodes are missed. The self-report Hypomania Checklist-32 (HCL-32) is a sensitive and reliable instrument with validated transcultural stability for detecting a history of hypomanic symptoms. The 33-item Hypomania Checklist (HCL-33) is a slightly modified version of the HCL-32. Alongside the HCL-33 self-report version, a new instrument for external assessment was developed. The objective was validation of the psychometric properties and the accuracy of the Russian version of the HCL-33 to identify BD in patients with a current diagnosis of RDD. The HCL-33 was completed by 150 outpatients and inpatients with a formal diagnosis of RDD in two Moscow state psychiatric settings. International Classification of Disorders (ICD-10) diagnoses were established using the Russian version of the Mini International Neuropsychiatric Interview (MINI). A screening score of 16 on the HCL-33 was the optimal cut-off that maximized sensitivity (0.71) and specificity (0.69) for the BD diagnosis. The highest Area Under the Curve (AUC) value during Receiver Operator Characteristic (ROC) analysis was 0.773 distinguishing between BD and RDD. The Cronbach's alpha was 0.91, indicating good internal consistency. Principal component analysis identified two factors, “active/elated” and “risk-taking/irritable”. The study scope was limited by the specific nature of the sample and the absence of comparison with other BD screening scales including HCL-32. The Russian version of the HCL-33 is a sensitive, accurate and reliable instrument for the screening of BD patients with depression.

Clinical factors associated with progression to dementia in people with late‐life depression: A cohort study of patients in secondary care

AbstractBackgroundDepression in later life is increasingly being recognised as a prodrome for the development of dementia. We aimed to investigate which clinical factors are associated with more rapid conversion from depression to dementia.MethodThe South London and Maudsley NHS Foundation Trust (SLaM) Clinical Record Interactive Search (CRIS) was used to retrieve anonymised data on patients who were aged 65 years or older and received a diagnosis of depression in mental health services, followed by a diagnosis of dementia >3 months later. Predictors of accelerated dementia development were investigated including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence, and treatments including psychotropic drugs and cognitive behavioural therapy (CBT).ResultIn 806 patients with late‐life depression who later received a diagnosis of dementia, significant predictors of shorter time to dementia diagnosis in fully adjusted models were older age, male gender, higher deprivation, and HoNOS65+ subscales measuring depressed mood and cognitive problems. A diagnosis of recurrent depressive disorder was independently associated with a longer time to dementia diagnosis. Antipsychotic drugs and CBT were significantly associated with longer times to dementia diagnosis when adjusted for demographic factors and severity of mood and cognitive difficulties, but not in fully adjusted models.ConclusionIn older adults with depression and subsequent dementia diagnosed by mental health services, faster progression to a diagnosis of dementia was predicted by age and gender, new onset depression, and severity of depressive and cognitive symptoms.

Urothelial toxicity of esketamine in the treatment of depression

RationaleKetamine is the first widely used substance with rapid-onset antidepressant action. However, there are uncertainties regarding its potential urothelial toxicity, particularly after repeated application. In the context of rising recreational ketamine use, severe side effects affecting the human urinary tract have been reported. It is assumed that ketamine interacts with bladder urothelial cells and induces apoptosis.ObjectivesThis study aimed to assess whether single or repeated doses of esketamine used in an antidepressant indication are associated with urinary toxicity.MethodsWe included male and female inpatients with a current episode of depression and a diagnosis of recurrent depressive disorder, bipolar disorder or schizoaffective disorder according to ICD-10 criteria (n = 25). The esketamine treatment schedule involved a maximum of 3× weekly dosing at 0.25–0.5 mg/kg i.v. or s.c. The primary outcome was the change in urine toxicity markers (leukocytes, erythrocytes, protein and free haemoglobin). Description of demographic, clinical and laboratory data was conducted using means, standard deviations, frequencies and percentages. Changes in urinary toxicity markers over time were evaluated using linear mixed models with gender as a covariate.ResultsThe participants received an average of 11.4 (SD 8) esketamine treatments, and an average number of 11.2 (SD 8) urine samples were analysed over the course of treatment. Neither urinary leukocyte concentration (F(20; 3.0) = 3.1; p = 0.2) nor erythrocyte concentration (F(20;2.2) = 4.1; p = 0.2) showed a significant trend towards increase during the course of esketamine treatment. Similarly, free haemoglobin and protein concentrations, which were analysed descriptively, did not display a rise during treatment. There was a significant improvement in depression ratings after esketamine treatment (p < 0.001).ConclusionsThis study is, to the best of our knowledge, the first to focus on urothelial toxicity of esketamine used in antidepressant indication and dose. The results indicate that the use of single or repeated doses of esketamine is unlikely to cause urothelial toxicity. The results are in need of confirmation as sample size was small.

Comparative evaluation of depressive disorders in women and men

To study clinical characteristics of depression in women and men. One hundred and twenty women, aged from 18 to 65 years, and 67 age-matched men with the diagnosis of recurrent depressive disorder (RDD) (ICD-10 F33) were examined using a specially developed survey. Differences in the clinical picture and course of RDD in women and men were found. RDD in women develops at an earlier age, the number of attacks is greater but remissions are longer. However, complete remission is achieved more frequently in men. Most typical effect in the structure of depression in women is anxiety whereas melancholy prevails in men. Daily mood fluctuations and suicidal thoughts are characteristic of women. Motor retardation and decreased motivation are more frequent in men. Ideas of self-blame, avoidance of contacts with other people, adynamia, persistent sense of fatigue are more common in women. Sleep disorders are equally common in men and women but falling asleep disturbance and lack of sleep feeling are more common in women. Somatic symptoms of depression are generally more common in men as well as concomitant diseases of cardiovascular, respiratory and genitourinary systems. Men are more likely to abuse alcohol and other psychoactive substances. The identified characteristics of depression in women and men allow more accurate diagnosis and treatment recommendations.

Depressive disorder: Particularities of theory of mind

Introduction“Theory of mind” represents the cognitive ability to attribute mental states as belonging to others and it's essential in any social interaction.ObjectivesOur objective was to evaluate the capacity of emotion recognition in patients with recurrent depressive disorder.AimsThis study aimed to determine if theory of mind is influenced by psychotic features and the type of emotions distinguished.MethodsWe analyzed a sample of 45 patients with a diagnosis of recurrent depressive disorder (WHO ICD10) that was divided to include 23 patients with at least one episode with psychotic symptoms, while the rest had no history of psychotic symptoms. The “Reading the mind in the eyes” test was applied in an outpatient setting, in remission. The data has been processed in SPSS.ResultsThe study found that 72.72% of patients without psychotic symptoms have a low capacity of emotion attribution, while 27.72% demonstrated a normal capacity (P = 0.00252). The majority with a history of psychotic depression (82.60%) showed a low capacity of emotion recognition, while 17.39% had normal abilities (P = 0). None of the patients showed a high capacity of emotion recognition. There was a significant difference in the frequency of negative emotions recognition by all patients (77.77%), while only a few managed to detect positive emotions (22.22%), regardless of psychotic symptom history.ConclusionsIn itself, a history of recurrent depressive disorder is directly related to a reduced ability to correctly attribute emotions. Moreover, these patients are more likely to detect negative emotions rather than positive ones.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Misdiagnose bipolar disorder: About a case report

IntroductionEarly stages of bipolar disorder are sometimes misdiagnosed as depressive disorders. This symptomatology can lead to misinterpretation and under diagnosis of bipolar disorders.Objectives/aimsTo describe a patient with a new diagnosis of bipolar disorder after 23 years of psychiatric care.MethodsWe report a case of a 66-year-old man, with a previous psychiatric diagnosis of recurrent depressive disorder for the last 23 years, after a hospitalization in a psychiatric inpatient unit because of a major depressive episode. In subsequent years, he was regularly followed in psychiatric consultation with description of recurrent long periods of depressed mood requiring therapeutic setting, alternating with brief remarks of not valued slightly maladjusted behaviour. At 65, he came to the emergency room presenting with observable expansive and elevated mood, disinhibited behaviour, grandiose ideas and overspending, leading to his hospitalization with the diagnosis of a manic episode. In the inpatient unit care, we performed blood tests, cranial-computed tomography (CT) and a cognitive assessment. His medication has also been adjusted.ResultsLaboratory investigations were unremarkable. Cranial-CT showed some subcortical atrophy of frontotemporal predominance, without corroboration by the neuropsychological evaluation. The patient was posteriorly transferred to a residential unit for stabilization, where he evolved with major depressive symptoms that needed new therapeutic adjustment. Later he was discharged with the diagnosis of bipolar disorder.ConclusionsOur case elucidates the importance of ruling out bipolar disorder in patients presenting with depressive symptoms alternating with non-specific maladjusted behaviour, which sometimes can be a challenging task.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Serum BDNF as a peripheral biomarker of treatment-resistant depression and the rapid antidepressant response: A comparison of ketamine and ECT

BackgroundKetamine is associated with rapid antidepressant efficacy but the biological mechanisms underpinning this effect are unclear. Serum brain-derived neurotrophic factor (sBDNF) is a potential circulating biomarker of treatment-resistant depression (TRD) and ketamine response but it is unclear if this is a common target of both ketamine and electroconvulsive therapy (ECT), the current gold standard for TRD. Moreover, the impact of multiple ketamine infusions on sBDNF has not yet been established. MethodsThirty five TRD patients with a current DSM-IV diagnosis of recurrent depressive disorder received up to 12 ECT sessions (N=17) or up to three intravenous infusions of low-dose (0.5mg/kg) ketamine (N=18). Blood samples were taken over the course of the study for assessment of sBDNF. Symptom severity and response were monitored using the 17-item Hamilton Depression Rating Scale (HDRS). sBDNF was assessed in 20 healthy controls to allow comparison with TRD patients. ResultsAs expected, sBDNF was lower in TRD patients at baseline compared to healthy controls. Ketamine and ECT treatment were both associated with significant reductions in depressive symptoms. However, sBDNF was significantly elevated only at one week following the first ketamine infusion in those classified as responders one week later. sBDNF was not elevated following subsequent infusions. ECT reduced depressive symptoms, as expected, but was not associated with an enhancement in BDNF. LimitationsPatients continued with their psychotropic medications throughout this trial. ConclusionsSBDNF normalisation does not appear to be a prerequisite for symptomatic improvement in TRD following ketamine or ECT treatment.

Underdiagnosis of Bipolar Disorder in Patients with Primary Diagnoses of Schizophrenia and Recurrent Depressive Disorder in Russian Federation (Observational, Non-interventional, Multicenter, Cross-sectional Diagnostic Study Maria).

Introduction The Bipolar Disorder (BD) is underdiagnosed condition worldwide. In Russia BD-II is mostly diagnosed as recurrent depressive disorder (RDD), and most cases of mania or depression with psychotic symptoms (so-called affective-delusional states) have diagnosis of schizophrenia. Objective To evaluate BD symptoms within the cohorts of inpatients with primary diagnoses of schizophrenia or RDD. Methods Patients with primary diagnosis of schizophrenia, schizoaffective disorder RDD were included. Bipolarity Index (BI) was the primary variable. Mini International Neuropsychiatric Interview (MINI) was used as a diagnostic tool. Personal and Social Performance Scale (PSP), Hypomania Checklist (HCL-32), Angst criteria for bipolarity were used for evaluation. Medical history, demographic and clinical data were analyzed. Results From 741 patients included in the study, only 12% of them reached diagnostic validity for BD using only BI (score ≥60). Using MINI and clinical data the diagnosis was revised to BD in 286 patients (38.6%). BD-I was diagnosed mostly in patients with former diagnosis of acute schizophrenia, BD-II was diagnosed exclusively in patients with former diagnosis of RDD. Mean PSP score in patients with BD was significantly higher (61.5±17.4 score) than in patients with the diagnosis of psychotic syndrome (39.3±16.2) and closer to that one in patients with RDD (63.0±16.8). Conclusions In our study BI has not shown to be proper screening instrument for bipolar spectrum disorders. BD is underdiagnosed in Russia. ClinicalTrials.gov Identifier: NCT01028196. Supported by funding from AstraZeneca Pharmaceuticals.

Exacerbation of Depression as a Predictor of Chronic Complications of Type 2 Diabetes Mellitus

Chronic complications of type 2 diabetes represent a serious threat to the health and quality of life of the patient. The most common include retinopathy, angiopathy, neuropathy. Development of such pathological conditions is affected with a number of risk factors, including comorbid depression. The aim of the study was to assess the impact of depression on the risk of complications of type 2 diabetes. Objectives - to assess the severity of depression - to Identify depression structure Methods The study involved 50 patients with a diagnosis of recurrent depressive disorder. All patients were diagnosed with non-insulin-dependent diabetes mellitus. Assessment of patients was carried out twice: on admission to a psychiatric hospital and at 1 year. Used psychometric method – HDRS-21 scale. Results: we found an association between the severity of depressive symptoms and an increased risk of complications of type 2 diabetes mellitus. New complications developed in 30% of patients after a year of observation. These patients had a comparatively high level of depression on a first visit (mean score on a scale of HDRS 19.2 (SD = 7.5) vs. 16.3 (SD = 6.2) with the rest of patients). The difference of the average score was conditioned by differences in the level of mental anxiety (1.33 points, 95% CI = 0.8-1.87, p Conclusion The increase of depressive symptoms level in patients with diabetes mellitus type 2 can indicate decompensation in endocrine disease.

Bipolar II disorder in patients with a current diagnosis of recurrent depression

The prevalence of bipolar II disorder (BD-II) in Russia has never been studied. Therefore, we sought to identify patients meeting diagnostic criteria for BD-II among patients with a current diagnosis of recurrent depressive disorder (RDD) through the use of the Russian versions of the Hypomania Checklist (HCL-32) and Bipolarity Index scales for differentiating between BD-II and RDD. In a non-interventional diagnostic study, we selected 409 patients aged between 18 and 65 years from two medical settings with (i) a current diagnosis of RDD, (ii) an illness duration of at least three years, and (iii) at least two affective episodes. The diagnosis was based on clinical assessment and confirmed by the Russian version of the Mini International Neuropsychiatric Interview. All patients were assessed by the HCL-32, the Bipolarity Index, and the Personal and Social Performance Scale. Among patients with a current diagnosis of RDD, 40.8% had a diagnosis of bipolar disorder (bipolar I disorder: 4.9%; BD-II: 35.9%). The average time lag from onset to a correct diagnosis of BD-II was 15 years and patients were treated only with antidepressants. The sensitivity of the Russian version of the HCL-32 at the optimal cutoff point (≥14.0) was 83.7%, and its specificity was 71.9%. The Bipolarity Index showed significant differences between the total scores of the patients with BD-II and RDD (31.8 versus 20.2; p < 0.0001). The optimal threshold was ≥22.0 (sensitivity 73.5%; specificity 72.3%). In Russia, diagnostic errors are an important cause of the non-detection of bipolar disorder, particularly BD-II. The Russian version of the HCL-32 and the Bipolarity Index, as additional tools, could be useful for bipolarity screening.

Validation of the Russian version of the Hypomania Checklist (HCL-32) for the detection of Bipolar II disorder in patients with a current diagnosis of recurrent depression

BackgroundThere are no validated screening tools for Bipolar Disorder (BD) in Russia. ObjectiveTo validate the Russian version of the HCL-32 for the detection of Bipolar II disorder (BD II) in patients with Recurrent Depressive Disorder (RDD). Methods409 patients with a current diagnosis of RDD were recruited. The diagnosis was confirmed by the validated Russian version of the Mini International Neuropsychiatric Interview (MINI). Another investigator interviewed the patients using the НСL-32 questions. ResultsThe total HCL-32 score in patients with BD II was significantly higher than in patients with RDD: 18.2 (4.22) versus 10.85 (5.81) (p<0.001, d=1447). At the cut-off 14 points the sensitivity was 83.7%, specificity 71.9% (p<0.001). The Cronbach's alpha was 0.887 that means good internal consistency.The best discrimination was achieved with 8 items: decreased need for sleep, less shyness or inhibition, talkativeness, more jokes and puns, jumping thoughts distractibility, exhausting or irritating others and high and more optimistic mood. We proposed the reduced variant of the scale, that includes only these 8 variables, with sensitivity 90.5%, specificity 69.8% (AUC=0.88). ConclusionsThe Russian version of the HCL-32 displayed a good ratio of sensitivity to specificity and can be recommended as a validated screening instrument. An 8-item version of HCL needs further research. LimitationsLimitations include the specific nature of the sample, the HCL-32 assessment carried out by a psychiatrist, no comparison with other BD screening scales. The results of the 8-item version may be sample and culture dependent.

Metabolic syndrome and C-reactive protein in patients with depressive disorder on antidepressive medication

Recurrent depression is a psychiatric disorder of which etiology and pathogenesis might be related to immune response. Metabolic Syndrome (MetS) and its components are also strongly associated with elevated inflammatory indicators, as so as the body mass index (BMI) and total cholesterol levels. Objective of this study was to investigate if there was any difference in C-reactive protein (CRP) levels in patients with recurrent depressive disorder, treated with antidepressants, compared to a healthy control group of subjects and if there was an association between increased CRP levels and the presence of MetS in these two groups. Sixty subjects entered the study; of these 35 patients with the diagnosis of recurrent depressive disorder, while the healthy control group included 25 subjects. MetS was defined according to the NCEP ATP III criteria. The cut-off point for CRP was set at > 5 mg/L. There was no statistically significant difference in the prevalence of MetS and CRP values between the studied groups. Waist circumference and total cholesterol levels were significantly higher in the experimental group. Patients that fulfilled the criteria for MetS showed significantly higher values of central obesity and arterial hypertension in the experimental group as well. The elevated CRP levels were associated with increased frequency of MetS in depressed patients. Both CRP levels and metabolic risk profile screening, according to the international criteria, may be beneficial in order to obtain better assessment for depressive long-term medicated patients.

P02-94 - BDNF and NT3 concentrations in post-mortem brain tissue of individuals with recurrent depressive disorder

IntroductionNeurotrophines such as brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT3) have been implicated in the pathogenesis of depression and the therapeutic mechanism of antidepressants. Several clinical studies on depressive disorder (DD) have shown that levels of blood BDNF are diminished in depression and increase during antidepressant treatment. So far, only few studies have examined concentrations of neurotrophic factors in post-mortem brain tissue of individuals who suffered from DD.Objectives/aimsThe objective of the study was to show whether BDNF and NT3 levels in post-mortem brain tissue of individuals who suffered from recurrent DD and who had been treated with antidepressants differed compared to controls.MethodsSpecimens from cortical and limbic areas of post-mortem brain tissue of 7 individuals with an ante-mortem diagnosis of recurrent depressive disorder based on ICD-10 criteria (F33.0–F33.8) who received no psychotropic medication other than selective serotonin re-uptake inhibitors 6 months preceding death were selected. We compared the concentrations of BDNF and NT3 with 14 matched controls without any history of psychiatric disorder or treatment with psychotropic drugs.ResultsWe detected no significant differences of either NT 3 or BDNF concentrations in any of the brain regions examined in patients who had suffered from DD and had been treated with antidepressants compared to controls.ConclusionsThese findings could be interpreted as a neurotrophic effect of antidepressant treatment in patients with recurrent DD, supporting the notion that depression improvement is associated with neuroplastic changes. However, more research using post-mortem brain tissue is needed.

Kleine-Levin Syndrome and Response to Modafinil in a Young Woman

Kleine-Levin Syndrome and Response to Modafinil in a Young Woman

Late life depression: Challenge or curse for the general practitioner (GP). A cohort study

The aim of this study was to examine specificity of GP's care for elderly depressed patients. Among 17,000 examinees (10 GP-Offices) were extracted 231 patients with diagnosis of depressive episode (F32) and 152 with diagnosis of recurrent depressive disorder (F33) classified according to ICD-10. Older than 65 years were 134 depressed patients. Data were tracked longitudinally and obtained retrospectively for a 1-year period from 1st January to 31st December 2008. Questionnaire was designed for this study to estimate the care delivered to depressed patients. Logistic regression analysis showed that GP more often diagnosed depression in older patients, provided medical care for them and changed their therapy. The main therapy for up to 80% of elderly with diagnosis of recurrent depressive disorder was combination of pharmacotherapy and GP's support and psychiatrist psychotherapy, while more than 20% of elderly with diagnosis of depressive episode took only pharmacotherapy. In comparison with younger age group, elderly less frequently received psychotherapy and GP's support. GP has an important role in older depressed patient care, so improvement efforts could focus on GP's clinical skills of depression treatment, as well as therapy effectiveness and depression outcome for understanding treatment specificity within elderly.

Discussion

Ketamine is associated with rapid antidepressant efficacy but the biological mechanisms underpinning this effect are unclear. Serum brain-derived neurotrophic factor (sBDNF) is a potential circulating biomarker of treatment-resistant depression (TRD) and ketamine response but it is unclear if this is a common target of both ketamine and electroconvulsive therapy (ECT), the current gold standard for TRD. Moreover, the impact of multiple ketamine infusions on sBDNF has not yet been established.Thirty five TRD patients with a current DSM-IV diagnosis of recurrent depressive disorder received up to 12 ECT sessions (N=17) or up to three intravenous infusions of low-dose (0.5 mg/kg) ketamine (N=18). Blood samples were taken over the course of the study for assessment of sBDNF. Symptom severity and response were monitored using the 17-item Hamilton Depression Rating Scale (HDRS). sBDNF was assessed in 20 healthy controls to allow comparison with TRD patients.As expected, sBDNF was lower in TRD patients at baseline compared to healthy controls. Ketamine and ECT treatment were both associated with significant reductions in depressive symptoms. However, sBDNF was significantly elevated only at one week following the first ketamine infusion in those classified as responders one week later. sBDNF was not elevated following subsequent infusions. ECT reduced depressive symptoms, as expected, but was not associated with an enhancement in BDNF.Patients continued with their psychotropic medications throughout this trial.SBDNF normalisation does not appear to be a prerequisite for symptomatic improvement in TRD following ketamine or ECT treatment.