Duration Of Depressive Episode Research Articles

Duration and timing of depression and risk of family dissolution: A register-based cohort study of newly-formed Danish families

BackgroundDepression is detrimental to partnership stability. However, it remains unclear if and how the duration and timing of depression affect the risk of family dissolution. MethodsWe conducted a Danish register-based cohort study of newly-formed cohabiting and married couples in 2008 and 2009, who were followed from the second year after family formation. Depressive episodes were defined by individual-level prescription patterns of antidepressant drugs (ATC codes N06A) in either partner. Family dissolution was characterized by the discontinuation of a shared residential address. Using Longitudinal Targeted Minimum Loss-based Estimation, we estimated the risk of family dissolution after 5 years of follow-up under various lengths and timings of depressive episodes. ResultsThere were 102,335 families included. The covariate-adjusted risk of family dissolution in families without depressive episodes was 30.0 % (95 % CI 29.6–30.4 %) and 35.5 % (95 % CI 29.5–41.5 %) in families with at least one depressive episode during follow-up. The risk of family dissolution increased with the duration of depressive episodes to 42.2 % (95 % CI 40.8–43.6 %) for five coherent years of depression. Depression shortly after family formation carried higher risk of family dissolution; this risk was 42.3 % (95 % CI 38.4–46.3 %) for depression experienced in the first year of family formation versus 32.9 % (95 % CI 31.8–34.0 %) in the fifth year of family formation. LimitationsProxy measures of depression by antidepressant prescriptions fails to identify milder depression. Annual measures of family dissolution precluded more fine-grained analyses of time-intervals. ConclusionsDepression is disruptive to family stability, particularly with longer duration and early onset after family formation.

Subtypes of major depressive disorders and objectively measured physical activity and sedentary behaviors in the community

BackgroundLack of physical activity (PA) and high sedentary behavior (SB) may enhance mental health problems, including depression, and are associated with increased mortality. Aside from a large body of research on major depressive disorder (MDD) assessed as an entity and either PA or SB, few studies have examined associations among subtypes of MDD and both PA and SB simultaneously derived from wrist-worn accelerometers. Accordingly, our aim was to explore the associations among MDD subtypes (atypical, melancholic, combined atypical-melancholic and unspecified) and four actigraphy-derived behaviors combining the levels of PA and SB. MethodsThe sample stemmed from CoLaus|PsyCoLaus, a population-based cohort study, consisting of 2375 participants (55.1% women; mean age: 62.4 years) who wore an accelorometer for 14 days after a physical exam and subsequently completed a semi-structured psychiatric interview. Activity behaviors were defined according to the combination of the levels of moderate-to-vigorous intensity PA and SB. Associations of remitted MDD subtypes, current MDD and physical inactivity behaviors were assessed using multinomial logistic regression, adjusted for socio-demographic characteristics, a history of anxiety, alcohol and drug use disorders and cardiovascular risk factors. ResultsIn the fully adjusted model, participants with the remitted combined atypical-melancholic subtype had a higher risk of being more physically inactive. ConclusionsOur findings suggest that low PA and high SB are not restricted to the duration of depressive episodes in people with atypical and melancholic episodes. The lack of PA and high SB in this group of depressive patients exposes them to an additional long-term cardiovascular risk and measures to increase PA may be particularly fruitful in this MDD subgroup.

Normative modeling analysis reveals corpus callosum volume changes in early and mid-to-late first episode major depression

BackgroundIt has been widely accepted that major depressive disorder (MDD) impacts brain structures including the Corpus Callosum (CC). However, this assumption is based on scarce literature data involving small sample sizes. Furthermore, it is still unclear whether such CC volume changes may already be present at a first depressive episode. MethodsTo further investigate this question, we compared 369 first-episode MDD patients (mean age = 35 years (sd = 12), 249 females; 283 early onset, 86 mid-to-late onset) from the open-source REST meta-MDD database closely matched for age and gender to 490 never-depressed individuals (mean age = 37 years (sd = 14); 309 females) using Z-scores obtained from normative neuroanatomical modeling to assess individual variability in CC (sub)volumes. ResultsRelative to the norms established by the healthy controls, first-episode MDD patients displayed CC volume (z-score) reductions in the entire CC (including the body), as did mid-to-late-onset first-episode MDD patients (age ≥ 45 y). In early-onset first-episode MDD patients (age ≤ 44 y), depression severity symptoms were related to volume increases in the entire CC, as well as the body and splenium. LimitationsNo data on depressive episode duration. Relatively small sample size for mid-to-late first-episode MDD patients. ConclusionsOur data revealed CC (sub)volume differences in early versus mid-to-late onset first episode MDD. Especially at early onset, depression severity may result in neural white matter activity as potential reaction to stress influences. Our results underline the importance of prompt clinical interventions at early onset MDD.

An Open Comparative Randomized Study of the Effectiveness and Safety of Risperidone and Sodium Valproate for Secondary Prevention of Relapses of Bipolar Disorder I for 24 Months

Background: Comparative studies of monotherapy with second-generation antipsychotics (SGA) or mood stabilizers in the prevention therapy of Bipolar Disorder (BD) relapses, including those with psychotic symptoms, have not been conducted. Objective: a comparative study of the clinical features of risperidone (RIS) and sodium valproate (SV) in the prevention of relapses of BD. Patients and methods: 96 patients with BD-I (F31, ICD-10) were included, the duration of the disease was at least 2 years, the presence of at least two affective episodes (including psychotic symptoms). Design — open comparative randomized study. Study duration was 24 months. Patients were sequentially divided into groups of RIS and SV, comparable in the number of patients, clinical and sociodemographic indicators. The effectiveness of therapy was determined by comparing the indicators of the dynamics of the course of the disease for 2 years preceding the start of therapy (control period) and 2 years after the treatment beginning. Results: 14 patients dropped out in the first month after the start of therapy due to adverse events, 82 completed the study. The total duration of episodes decreased by 40-60%, the frequency — by 37.2% — 43.3% (p ≤ 0.05). The proportion of responders in the RIS group was 78.1%, SV — 68.3%. Complete suppression of phase formation was observed in 43.75% in the RIS group, in 10.7% — in the SV group. In the RIS group, the total duration of depressive episodes decreased by 38.3% (NS), manic by 65.2% (p ≤ 0.001), in the SV group — by 31.9% (NS) and by 52.9% (p ≤ 0.05), respectively. As to BD with psychotic symptoms, 85% of respondents were in the RIS group, and 50% were in the SV group. The average number of adverse events per patient in the group of SV was 0.9, RIS — 2.1. Conclusions: SV and RIS are comparable in effectiveness with better tolerance of SV. In patients with psychotic symptoms, the effectiveness of RIS was higher than that of SV.

Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data.

Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression. For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level. Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = -0.49, 95% confidence interval (CI) -0.61 to -0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = -0.68, 95% CI -1.31 to -0.05, p = 0.03) and than 1-2 years (B = -0.86, 95% CI -1.66 to -0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias. To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.

Clinical Course in Patients With Melancholic and Nonmelancholic Bipolar Depression.

The aim of the current study was to compare the longitudinal clinical course of patients with a history of melancholic and nonmelancholic bipolar depression. Seventy-seven euthymic outpatients with bipolar disorder were categorized as melancholic or nonmelancholic through the clinician-rated Sydney Melancholia Prototype Index. Clinical course was assessed for a period longer than 48 months by time spent ill, density of affective episodes, severity and duration of depressive episodes, and time to depressive recurrence. The mean follow-up time was 69.05 months. Patients with melancholic depressions had more severe and longer depressive episodes during follow-up, whereas patients with nonmelancholic depressions had a shorter time to depressive recurrence and more subsyndromal depressive symptoms and affective instability. These findings highlight the heterogeneity inherent to the current construct of bipolar depression and position melancholia as an interesting target for comparison with nonmelancholic depressions in other external validators in the field of bipolar disorder.

Association of disease course and brain structural alterations in major depressive disorder.

The investigation of disease course-associated brain structural alterations in Major Depressive Disorder (MDD) have resulted in heterogeneous findings, possibly due to low reliability of single clinical variables used for defining disease course. The present study employed a principal component analysis (PCA) on multiple clinical variables to investigate effects of cumulative lifetime illness burden on brain structure in a large and heterogeneous sample of MDD patients. Gray matter volumes (GMV) was estimated in n = 681 MDD patients (mean age: 35.87 years; SD = 12.89; 66.6% female) using voxel-based-morphometry. Five clinical variables were included in a PCA to obtain components reflecting disease course to associate resulting components with GMVs. The PCA yielded two main components: Hospitalization reflected by patients' frequency and duration of inpatient treatment and Duration of Illness reflected by the frequency and duration of depressive episodes. Hospitalization revealed negative associations with bilateral dorsolateral prefrontal cortex (DLPFC) and left insula volumes. Duration of Illness showed significant negative associations with left hippocampus and right DLPFC volumes. Results in the DLPFC and hippocampus remained significant after additional control for depressive symptom severity, psychopharmacotherapy, psychiatric comorbidities, and remission status. This study shows that a more severe and chronic lifetime disease course in MDD is associated with reduced volume in brain regions relevant for executive and cognitive functions and emotion regulation in a large sample of patients representing the broad heterogeneity of MDD disease course. These findings were only partly influenced by other clinical characteristics (e.g., remission status, psychopharmacological treatment).

Differential Placebo Responses for Pharmacotherapy and Neurostimulation in Late-Life Depression

BackgroundThe magnitude of the placebo response depends on both the modality used as the “placebo” and the intervention with which it is compared, both of which can complicate the interpretation of randomized controlled trials (RCTs) for depression in late life. Given that neurostimulation and pharmacotherapy are among the most common interventions studied for late-life depression, comparing the relative placebo responses in studies of these interventions can aid interpretation of relative effect sizes. Materials and MethodsWe analyzed data from two RCTs of adults aged ≥60 years in an episode of treatment-resistant major depression, one comparing aripiprazole and matching placebo pills and the other comparing deep repetitive transcranial magnetic stimulation (rTMS) and sham rTMS. In both RCTs, depression was assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17). The primary comparison occurred after four weeks using analysis of covariance (ANCOVA) of HDRS-17 scores in participants who received placebo pills or sham rTMS. Relevant covariates included years of education, duration of depressive episode, and baseline HDRS-17 score. ResultsAccounting for covariates, there was a larger reduction of HDRS-17 after four weeks in the sham rTMS group (estimated marginal mean ± SE: −5.90 ± 1.45; 95% CI: [−8.82, 2.98]) than in the placebo pills group (−1.07 ± 1.45; [−3.98, 1.85]). There were no significant differences between these groups in the binary outcome analysis of response and remission rates at four weeks or any outcome at trial end point comparison. ConclusionsSham rTMS may have a larger placebo response than placebo pills early in the treatment of older adults with treatment-resistant depression. Differential placebo responses should be considered in both the interpretation and design of RCTs.

Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling.

BackgroundFamily history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi‐informant design to examine whether a child’s FHD adds information about future depressive episodes and depression severity applying state‐of‐the‐art predictive out‐of‐sample methodology.MethodsWe examined data in adolescents with current or past depression (age 11–17 years) from the National Institute of Mental Health Characterization and Treatment of Adolescent Depression (CAT‐D) study. We asked whether a history of depression in a first‐degree relative was predictive of depressive episode duration (72 participants) and future depressive symptom severity in probands (129 participants, 1,439 total assessments).ResultsFamily history of depression, while statistically associated with time spent depressed, did not improve predictions of time spent depressed, nor did it improve models of change in depression severity measured by self‐ or parent‐report.ConclusionsFamily history of depression does not improve the prediction of the course of depression in adolescents already diagnosed with depression. The difference between statistical association and predictive models highlights the importance of assessing predictive performance when evaluating questions of clinical utility.

Clinical features of depression in adolescents with schizotypal disorder

To study the clinical features of depressive disorders in adolescents with schizotypal disorder (STD). Were examined 87 adolescents with STD (F21), taken for outpatient or inpatient observation in 2018-2020. Of these, 26 patients were selected (12 males, 14 females, mean age 12.7±2.9 years) diagnosed with clinically significant depression (F32). To assess the severity of depression, the Hamilton Depression Rating Scales (HDRS) and the Beck Depression Self-Assessment Questionnaire (BDI) were used. The SPQ questionnaire was used to quantify the presence of STD symptoms. Depressive disorders were observed in 28% of all examined patients with STD. Signs of dysontogenesis were observed in 92% of the examined. The duration of depressive episodes before the start of treatment averaged 8.7 months, and until therapeutic remission was achieved, an average of 12.6 years. A mild depressive episode according to the HDRS scale corresponded in 23.1% of patients with a moderate degree in 61.5% and a severe one in 3.8%. At the same time, according to the BDI questionnaire, the results were different: there was no mild degree of depression during treatment, moderate-severe degree was detected in 8 (30.1%) patients, in the remaining 16 (61.5%) - extremely severe degree. Suicidal thoughts were noted in 76.9% of the surveyed, while the parents knew about their presence only in 27.0% of adolescents. A suicidal attempt was made by 3 patients (11.5%), one of them repeatedly. Non-suicidal self-injurious behavior was found in 38.5% of patients. Depressive episodes in adolescents with STD are noted chkasto, characterized by the duration and severity of symptoms. Subjective depressive experiences, primarily internal feelings of longing, ideas of failure and guilt, as well as the frequency of anti-vital thoughts and self-injurious behavior, are much more pronounced in adolescents than they demonstrate in everyday life.

Cost-Effectiveness of Providing the Depression Care for People With Cancer Program to Patients With Prostate Cancer in the United States

ObjectivesThe Depression Care for People with Cancer program (DCPC) is a cost-effective depression care model for UK patients with cancer. However, DCPC’s cost-effectiveness in the United States is unknown, particularly for patients with prostate cancer in the United States. This study evaluates the health and economic impact of providing DCPC to patients with prostate cancer. MethodsDCPC was compared with usual care in a mathematical model that simulates depression and its outcomes in a hypothetical cohort of US patients with prostate cancer. DCPC was modeled as a sequential combination of universal depression screening, post-screening evaluations, and first-line combination therapy. Primary outcomes were lifetime direct costs of depression care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Secondary outcomes included life expectancy, number of depression-free months and lifetime depressive episodes, duration of depressive episodes, cumulative incidence of depression, lifetime depression diagnoses/misdiagnoses, and the cumulative incidence of maintenance therapy for depression. Sensitivity analyses were used to examine uncertainty. ResultsIn the base case, DCPC dominated usual care by offering 0.11 more QALYs for $2500 less per patient (from averted misdiagnoses). DCPC also offered 5 extra depression-free months, shorter depressive episodes, and a lower chance of maintenance therapy. DCPC’s trade-offs were a higher cumulative incidence of depression and more lifetime depressive episodes. Life expectancy was identical under usual care and DCPC. Sensitivity analyses indicate that DCPC was almost always preferable to usual care. ConclusionCompared with usual care, DCPC may offer more value to US patients with prostate cancer. DCPC should be considered for inclusion in prostate cancer survivorship care guidelines.

Characteristics of Executive Functions in Patients With Cognitive Impairments in the Presence of Depressive Disorders

Introduction. The urgency of the problem of affective pathology and, above all, depression, due to a number of factors: the growing prevalence of depression, reaching 10.0 % in the population, the high risk of chronic such conditions, their maladaptive impact on social functioning, efficiency and quality of life, the burden of economic costs etc. According to epidemiological indicators in Ukraine over the past 10 years, the incidence of affective disorders has increased by 6.13 %, and the prevalence – by 13.16 %. Impaired thinking and executive functions, decreased concentration and difficulty making decisions are key diagnostic signs of depression. Cognitive impairment (CI) has a cumulative effect on the functionality of patients with depression and is associated with a longer duration of depressive episodes, which indicates the need for its diagnosis and treatment. At the present stage, there are no systematic ideas about the specifics of disorders of executive functions in the presence of different types of depressive disorders (DD), which determines the relevance of the study in this direction. The aim of the study. Describe the executive functions in patients with CI in the presence of DD. Materials and methods. The study included 362 patients with CI in the presence of DD, which were stratified into three groups of comparisons by the mechanism of DD: 123 patients with recurrent depressive disorders (RDD), 141 patients with bipolar affective disorder (BAD) and 98 people with prolonged depressive reaction (PDR). The predominant numbers (38.12 %) of patients with CI in the presence of DD were in adulthood (30-44 years). There were more young people (18-29 years) among patients with PDR (21.43 %, DC = 8.19) and among patients with BAD (31.21 %, DC = 9.82), and middle-aged people (45-59 years) (37.40 %, DC = 1.54) and the elderly (60-74 years) (17.07 %, DC = 4.78) – among patients with RDD. A set of research methods was used: clinical-psychopathological, psychodiagnostic and statistical. Results. Peculiarities of executive functions in patients with CI in the presence of DD were established: the moderate and severe disorders of visual-motor coordination (39.84 % and 19.51 %, respectively) and impaired visual-spatial functions (13.72 %), moderate and severe violations of executive functions (54.47 % and 13.01 %, respectively), moderate, severe and weak violations of the executive function of the lexical system (39.84 %, 32.52 % and 23.58 %, respectively) were present in patients with RDD; the moderate violations of verbal performance (58.54 %); moderate and severe violations of visual-motor coordination (41.13 % and 26.24 %, respectively), executive functions (65.96 % и 21.38 %, respectively), executive functions of the lexical system (47.52 % и 39,01 %, respectively) and verbal productivity (58.16 % and 21.28 % respectively) were found in BAD; absence and weak impairments of visual-motor coordination (45.92 % and 36.73 %, respectively), executive functions (23.47 % and 66.33 %, respectively), executive functions of the lexical system (31.63 % and 45.92 %, respectively) and verbal productivity (26.53 % and 58.16 %, respectively) were presented in patients with PDR. Conclusions. The study revealed the features of executive functions in patients with cognitive impairment in the presence of depressive disorders, which should be taken into account in the algorithm of their psychosocial rehabilitation.

Characterization of rapid cycling bipolar patients presenting with major depressive episode within the BRIDGE-II-MIX study.

The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as rapid cycling (RC). Psychiatric symptoms, socio-demographic, and clinical variables were collected from a sample of 2811 MDE patients, of which 726 (25.8%) were diagnosed with bipolar disorder (BD). The characteristics of bipolar patients with RC (BD-RC) and without (BD-NRC) RC were compared. Of 726 BD patients, 159 (21.9%) met DSM-5 criteria for RC. BD-RC group presented a higher number of lifetime depressive episodes (p<0.001) with shorter duration of depressive episodes, and more psychiatric comorbidities, as well as higher rates of atypical features (p=0.016) and concomitant (hypo)manic symptoms (irritable mood (p=0.001); risky behavior (p=0.005); impulsivity (p=0.006); and psychomotor agitation (p=0.029)). Patients with RC had a worse functioning (p=0.033), more obesity (p=0.003), and were significantly more likely to be treated with three or more drugs (p=0.007). Important clinical differences between bipolar patients with and without a RC include more depressive morbidity, higher incidence of anxiety disorders, addiction, bulimia, and borderline personality disorder, as well as atypical features during depression and symptoms such as irritability, risky behavior, impulsivity, and agitation. RC patients had poorer functioning than patients without RC, more obesity, and had to be treated with more drugs.

Neural correlates of mindful emotion regulation in high and low ruminators

Depressive rumination is considered a prominent risk factor for the occurrence, severity, and duration of depressive episodes. A variety of treatment options have been developed to treat depressive rumination of which mindfulness based programs are especially promising. In the current study, we investigated the neural underpinnings of a short mindfulness intervention and mindful emotion regulation in high and low trait ruminators in an ecologically valid environment using functional near-infrared spectroscopy (fNIRS). Participants were randomly assigned to a mindfulness instruction (MT) group or an instructed thinking (IT) group. Participants in the MT group were trained to either focus their attention mindfully on their breath or their emotions, while the IT group focused their attention on the past or future. Afterwards, all participants underwent an emotion regulation paradigm in which they either watched negative or neutral movie clips. During both paradigms cortical hemodynamic changes were assessed by means of fNIRS. Participants in the MT group showed lower activity in the cognitive control network (CCN) during the focus on breath condition in comparison to the focus on emotion condition. Additionally, oxygenated hemoglobin in the MT group tended to be lower than in the IT group. Further, self-reports of emotional distress during the instruction paradigm were reduced in the MT group. During the emotion regulation paradigm, we observed reduced emotional reactivity in terms of emotional distress and avoidance in the MT group in comparison to the IT group. Furthermore, on a neural level, we observed higher CCN activity in the MT group in comparison to the IT group. We did not find any effect of rumination, neither on the intervention nor on the emotion regulation task. The results of this pilot study are discussed in light of the present literature on the neural correlates of mindfulness based interventions in rumination and emphasize the use of fNIRS to track neural changes in situ over the course of therapy.

ECT AMPLITUDE AND CLINICAL OUTCOMES

Introduction ECT is recognized for its efficacy in the treatment of depressive disorders, however neurocognitive impairment remains a major concern of treatment. Demographic factors, depression severity, and ECT treatment parameters influence neurocognitive outcomes. Studies examining ECT electrode placement and pulse width find that more focal stimulus delivery with right unilateral placement or ultrabrief pulse width can reduce cognitive side effects, however are associated with less efficacy than standard treatments. Pulse amplitude, which determines the induced electric field strength in the brain, is currently set at 800-900?mA on modern ECT devices without any clinical or scientific rationale. Lower pulse amplitudes also produce more focal electric fields and potentially reduce neurocognitive impairment. Recent small studies have demonstrated that low amplitude ECT can generate seizure induction, may improve depression severity, and result in fewer cognitive side effects. There are not yet prospective randomized studies examining the antidepressant and neurocognitive dose-response relationship relative of ECT pulse amplitude. The present study compares three different pulse amplitudes during an ECT series. We hypothesize that the lower amplitudes will maintain the antidepressant efficacy of the standard treatment and reduce the risk of neurocognitive impairment. Methods The present study (ClinicalTrials.gov identifier NCT0299929) prospectively randomized subjects to three treatment arms: 600mA, 700mA, and 800mA (active comparator). Clinical, neuropsychological, and imaging assessments were conducted pre-, mid- (after the sixth ECT treatment) and post-ECT (within one week of finishing the ECT series). Subjects had a diagnosis of major depressive disorder, met the clinical indication for ECT, were between 50 and 80?years of age, and right-handed. Depression severity was tracked using the Hamilton Depression Rating Scale 24-item (HDRS-24). The neuropsychological battery is focused on detecting longitudinal differences in hippocampal-dependent changes in cognitive performance. Our primary outcome measure was the Hopkins Verbal Learning Test-Revised (HVLT-R) raw retention score. All subjects were treated with right unilateral electrode placements with either ultrabrief pulse width (0.3 ms) or brief pulse widths (1.0ms, used for the last 14 subjects following interim data analysis). Treatments were individually titrated to supra-threshold, with subsequent treatments given at 6x seizure threshold. Results For this analysis, we focused on subjects that completed all three time points with RUL electrode placement. 62 patients were randomized to the three different pulse amplitude groups and completed at least the first and mid- visits. Demographics, including age, sex, duration of depressive episode, number of lifetime episodes, and baseline cognitive status were not significantly different between groups. Initial HDRS-24 scores were similar. The lowest amplitude group (600 mA) in our study showed significantly less antidepressant effect compared to the higher amplitudes (700mA and 800mA). The amplitude groups did not have significant differences in our primary cognitive outcome, the HVLT-R retention score. Several of the secondary cognitive outcomes were more sensitive to detecting cognitive impairment than the Hopkins Verbal Learning Test, revealing that subjects receiving 800?mA demonstrated greater impairment effects compared to the lower amplitude. This was most sensitive in the Delis Kaplan Executive Function System (DKEFS)-Verbal Fluency subset, DKEFS-Color Word Interference, and Dot Counting Test. Conclusions This study used a blinded randomized design to examine dose-dependent effects of pulse amplitude on depression response and neurocognitive measures. Despite seizure induction, treatment with the 600mA pulse amplitude did not achieve clinical efficacy in comparison to higher amplitudes. These findings support the concept that seizure is necessary but not sufficient for treatment response. The primary cognitive outcome, the Hopkins Verbal Learning Test-Revised (HVLT-R) raw retention score, did not show significant difference between amplitudes. However, neurocognitive battery outcomes of verbal fluency, color-word interference, and dot counting showed sensitivity in the secondary analyses. Focal electric field exposure through reduction of pulse amplitude may be beneficial in limiting the effects of some aspects of cognitive impairment. Limitations of our study include attrition and missing data from for some subjects who could not complete the full neurocognitive battery. Further work on understanding ECT treatment parameters can optimize and individualize care for patients undergoing ECT, maximizing benefit and reducing cognitive risk. This research was funded by: BRAIN Initiative U01 MH111826

The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment.

Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.

Prévalence et caractéristiques de la dysfonction sexuelle chez des patients marocains consultant pour un premier épisode dépressif

Depression as such causes emotional and physical disturbances that affect biological functions such as sleep, appetite, decreased libido and lack of interest in sexual function. Indeed, there is a significant incidence of sexual dysfunction in depressed patients. In addition, depression and sexual dysfunction have a significant impact on the quality of life of couples which can be improved by managing these two conditions between which there seems to be a two-way causal link. Sexual dysfunction has long been neglected in the clinic of depression. In Morocco, depression affects more than a quarter of the population. However, to date, no study has focused on the assessment of sexual function in relation to depression among Moroccans. ObjectivesThis work aimed to evaluate the prevalence and characteristics of sexual dysfunction in Moroccan patients consulting for a first depressive episode. MethodsThis is a descriptive cross-sectional study. All subjects included in this study were consulting for a first major depressive episode according to DSM-5 criteria from June 1st to November 30th, 2017 at the psychiatric university department at Ibn Nafis hospital in Marrakech. The severity of depression was assessed using the Hamilton scale. The ASEX (Arizona Sexuel Experience) scale was used to define sexual dysfunction. Statistical analysis was performed using SPSS 22 software. ResultsFifty eight patients were recruited 34 of whom were female. They had an average age of 37 years. The majority were between 27 and 42 years old (59 %), married (81 %), with an average level of education (34.5 %). The average duration of the episode was 57 days. The major depressive episode was severe in 62 % of patients. According to the ASEX, 77.6 % of the depressed patients had a clinically significant sexual dysfunction. The majority of our patients (60.3 %) consulting for depression attach their sexual dysfunction to their depressed mood, either by reporting the onset of sexual dysfunction at the same time as depression (53.4 %), or worsening after the depression onset (6.9 %). The frequency of sexual intercourse with the pre-depressive state was decreased in the majority of our sample. Sexual desire was the most impaired phase of the sexual response (58.6 %) followed by excitation (53.4 %) and then orgasm (51.7 %). Of the 47 married patients, more than two thirds (32 patients) were dissatisfied with their life as a couple as well as with different aspects of their relationship life. The majority of patients reporting marital dissatisfaction attributed the cause to the quality of their sexual intercourses rather than to their frequency or other relational aspects. Sexual dysfunction was significantly correlated with the severity of depression (P=0.031), whereas it was not correlated with duration of depressive episode (P=0.412) or age or patient sex (P=0.114, P=0.202 respectively). ConclusionsThe prevalence of sexual dysfunction is high in depressed patients. It significantly impacts the couple's quality of life. Although our main limitation was the small sample size which prevented us from doing a multi-varied analysis, the robust nature of this study lies in documenting the initial prevalence and types of sexual dysfunctions in both sexes in the first major depressive episode unrelated to the dysfunctions induced by antidepressant drugs. The early identification of sexual disorders and the consideration of couple dynamics would be two important elements in the management of the depressed patient.

When Is ECT Right for Your Patients With Depression?

Some variables help predict ECT outcomes and present an algorithm to assist psychiatrists decide which patients are candidates for ECT.

Attrition in treatment-resistant depression: predictors and clinical impact.

The aim of this study was to investigate attrition (dropout) during a second antidepressant trial in treatment-resistant depression. Three hundred forty-two outpatients with major depressive disorder and lack of response to a prior antidepressant were treated with venlafaxine for 6 weeks. Sociodemographic and clinical characteristics were compared between the attrition and non-attrition groups. Attrition was reported in 65 patients (19%), of whom 30 patients (46%) dropped out within week 4. The characteristics of dropout patients included a longer duration of depressive episode (P = 0.011) and lower antidepressant doses (P < 0.0001) as a consequence of a faster decrease (week 2) in depressive symptoms (P = 0.028). However, by controlling for early improvement, dropout subjects were associated with a smaller probability of antidepressant response (odds ratio = 0.16▪.83). A decrease of at least 30% in Montgomery Asberg Depression Rating Scale on day 14 predicted subsequent dropout with high specificity (81.9%▪1.0%) but lower sensitivity (19.6%▪2.8%) for clinical use. Patients who have been depressed for a longer period and show an initial improvement of symptoms after changing their antidepressant may be at increased risk for drop out. Further studies are necessary to ascertain the usefulness of these characteristics for predicting attrition.

Functional Connectivity Between Extrastriate Body Area and Default Mode Network Predicts Depersonalization Symptoms in Major Depression: Findings From an A Priori Specified Multinetwork Comparison

BackgroundDepersonalization/derealization disorder is a dissociative disorder characterized by feelings of unreality and detachment from the self and surroundings. Depersonalization/derealization disorder is classified as a primary disorder, but depersonalization symptoms are frequently observed in mood and anxiety disorders. In the context of major depressive disorder (MDD), depersonalization symptoms are associated with greater depressive severity as indexed by treatment resistance, inpatient visits, and duration of depressive episodes. In the current investigation, we tested four network-based, neural-functional hypotheses of depersonalization in MDD. These hypotheses were framed in terms of functional relationships between 1) extrastriate body area and default mode network (DMN); 2) hippocampus and DMN; 3) medial prefrontal cortex and ventral striatum; and 4) posterior and anterior insular cortex. MethodsWe conducted functional magnetic resonance imaging during resting state on 28 female patients with MDD and 27 control subjects with no history of a psychiatric disorder. Functional connectivity between seed and target regions as specified by our network-level hypotheses was computed and correlated with scores on the Cambridge Depersonalization Scale. We used a conservative, unbiased bootstrapping procedure to test the significance of neural-behavioral correlations observed under each of the four models tested. ResultsOf the four neural-functional models of depersonalization symptoms tested, only the model proposing that reduced connectivity between the extrastriate body area and DMN predicts higher levels of depersonalization symptoms in MDD was confirmed. ConclusionsOur results indicate that depersonalization/derealization disorder symptoms in patients with depression are related to reduced functional connectivity between brain regions that are proposed to support processing of body-related (extrastriate body area) and autobiographical (DMN) information.