Duration Of Depressive Episode Research Articles

SA81 - UNRAVELING GENOMIC CONTRIBUTIONS TO VENLAFAXINE REMISSION IN OLDER ADULTS WITH LATE-LIFE DEPRESSION USING A GENOME-WIDE APPROACH

Background In geriatric depression, antidepressant treatment response is often slow and incomplete; new biomarkers for antidepressant response could lead to precision medicine and uncover new mechanisms of illness. Therefore, we conducted a Genome-Wide Association Study (GWAS) in older adults treated with venlafaxine. Methods Three-hundred and fifty participants (>60 years) of mixed ethnic ancestry, diagnosed with major depression (MADRS>15), were treated with venlafaxine (~12 weeks). Individuals were genotyped using the Illumina PsychArray, and genetic data was imputed to 7.5 million variants per individual. Associations with remission status (MADRS≤10) and change in MADRS score were conducted using logistic/ linear regressions, adjusted for ancestry, sex, recruitment site, length in treatment, depressive episode duration, and baseline depressive severity. We also conducted pathway enrichment analysis using DEPICT. Results Our top hits in association with MADRS score change were with variants near MIR1246 and in ERBB4, a schizophrenia susceptibility gene. ERBB4 has been implicated in post-ketamine treatment down regulation of GABA and glutamate levels in the rat prefrontal cortex and hippocampus, resulting in an antidepressant effect. We also observed a suggestive association between remission status and a variant in phosphodiesterase gene PDE9A, suggesting a role in synaptic neurotransmitter signaling. Our top hit pathways included processes in the metabolic pathway of amyloid precursor protein. However, no variants survived corrections for multiple testing (p Discussion Our findings suggest novel gene variant associations with measures of venlafaxine remission in older adults, as well as interesting neuro-relevant genetic pathways. A new, larger study of geriatric depression treatment will confirm these novel findings.

Early Menopause Is a Risk Factor for Postmenopausal Depression in Healthy Women, But Are Depressive Episodes a Risk Factor for Early Menopause?

Background: This study investigated whether age of menopause in bipolar women is different from that in healthy women and if there is a relationship between age at menopause and previous depressive episodes. Methods: We consecutively evaluated 86 euthymic and postmenopausal women who were older than 33 years and were diagnosed with bipolar disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The healthy control group comprised 100 individuals of similar age. After the diagnostic interview, bipolar patients completed the Mood Disorders Diagnosis and Follow-Up Form (SKIP-TURK). Results: Age at menopause in bipolar women was earlier than that of the controls (P = 0.001). Age at menopause correlated with age of onset of bipolar disorder (r = 0.453). A strong inverse correlation was found between the age of menopause and total duration of depressive episodes (r = -0.542). Conclusion: Early-onset bipolar disorder is associated with early ages of menopause. Age at menopause seems to be related to duration of depressive period. Considering the effects of hypoestrogenemia on ischemic heart diseases and cognitive impairment, it is important that the risk which is already high for both situations should be reduced, and depressive periods should be prevented. J Clin Gynecol Obstet. 2018;7(3-4):69-71 doi: https://doi.org/10.14740/jcgo504w

No evidence of seasonal variation in mild forms of depression

Background and objectivesSeasonal Affective Disorder (SAD) is ubiquitous in popular culture and has influenced psychiatric diagnosis with the inclusion of the seasonal pattern modifier for the Major Depressive Episode in DSM. However, recent research has not supported the association of Major Depressive Episode with seasonal changes. The present study was conducted to determine if a seasonally-related pattern of occurrence of mild variants of depression could be demonstrated in a population-based study. MethodsThis is a cross-sectional U.S. survey of adults who completed the PHQ-8 Depression Scale with mild depression defined using a PHQ-8 cut score and a second model based on the DSM-5 diagnosis, Depression with insufficient symptoms. Regression models were used to determine if either variant of mild depression was related to season, latitude, or measures of daylight hours. ResultsNeither measure of mild depression was related to daylight hours or its proxy measures. LimitationsScreening instruments for depression, even if consistent with DSM-5 diagnostic criteria, do not allow a formal diagnosis of depression or the exclusion of similar-appearing disorders. Current depression symptoms but not duration of depressive episode is measured. ConclusionsMild depression is not related to seasonal changes or proxy measures of light exposure. The findings cast doubt on light deficiency as a causal factor of depressive disorders, which underpins the inclusion of the seasonal pattern modifier in DSM-5 and light supplementation as a treatment modality.

Standardisation framework for the Maudsley staging method for treatment resistance in depression

BackgroundTreatment-resistant depression (TRD) is a serious and relatively common clinical condition. Lack of consensus on defining and staging TRD remains one of the main barriers to understanding TRD and approaches to intervention. The Maudsley Staging Method (MSM) is the first multidimensional model developed to define and stage treatment-resistance in “unipolar depression”. The model is being used increasingly in treatment and epidemiological studies of TRD and has the potential to support consensus. Yet, standardised methods for rating the MSM have not been described adequately. The aim of this report is to present standardised approaches for rating or completing the MSM.MethodBased on the initial development of the MSM and a narrative review of the literature, the developers of the MSM provide explicit guidance on how the three dimensions of the MSM--treatment failure, severity of depressive episode and duration of depressive episode-- may be rated.ResultThe core dimension of the MSM, treatment failure, may be assessed using the Maudsley Treatment Inventory (MTI), a new method developed for the purposes of completing the MSM. The MTI consists of a relatively comprehensive list of medications with options for rating doses and provisions treatment for multiple episodes. The second dimension, severity of symptoms, may be assessed using simple instruments such as the Clinical Global Impression, the Psychiatric Status Rating or checklist from a standard diagnostic checklist. The standardisation also provides a simple rating scale for scoring the third dimension, duration of depressive episode.ConclusionThe approaches provided should have clinical and research utility in staging TRD. However, in proposing this model, we are fully cognisant that until the pathophysiology of depression is better understood, staging methods can only be tentative approximations. Future developments should attempt to incorporate other biological/ pathophysiological dimensions for staging.

Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center

Background: Although there is abundant literature on stigma and its correlates in patients with severe mental illnesses such as schizophrenia and bipolar disorder, data on stigma experienced by patients with first-episode depression (FED) are limited. Aims and Objectives: To estimate internalized stigma perceived by patients with FED and to assess the relationship of stigma with sociodemographic and clinical variables. Methodology: This cross-sectional study included 107 patients with FED with duration of illness of at least 1 month, currently not meeting the criteria of syndromal depression (as assessed on Hamilton depression rating scale score ≤ 7). These patients were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma and Participation Scale for restriction of activities. Results: About two-fifths of patients (41.1%) reported stigma as per the total ISMIS score. In terms of various domains of stigma, stereotype endorsement (54.2%) was reported by the highest proportion of patients and this was followed by alienation (47.7%) and discrimination experience (38.3%). About half of the study sample (49.5%) reported restriction in participation with one-third of the sample reporting having severe or extreme restriction. Younger age, longer duration of depressive episode, and presence of comorbid physical illness were found to be strongly associated with higher level of stigma. Higher level of participation restriction was associated with higher level of stigma in the domains of alienation (P ≤ 0.001) and social withdrawal (P ≤ 0.004). Conclusions: The present study suggests that internalized stigma/self-stigma is highly prevalent among patients with FED. Accordingly, there is a need to develop stigma mitigation programs addressing these patients at the earliest to improve their treatment outcome.

Recent advances in predicting responses to antidepressant treatment.

Major depressive disorder is one of the leading causes of disability in the world since depression is highly frequent and causes a strong burden. In order to reduce the duration of depressive episodes, clinicians would need to choose the most effective therapy for each individual right away. A prerequisite for this would be to have biomarkers at hand that would predict which individual would benefit from which kind of therapy (for example, pharmacotherapy or psychotherapy) or even from which kind of antidepressant class. In the past, neuroimaging, electroencephalogram, genetic, proteomic, and inflammation markers have been under investigation for their utility to predict targeted therapies. The present overview demonstrates recent advances in all of these different methodological areas and concludes that these approaches are promising but also that the aim to have such a marker available has not yet been reached. For example, the integration of markers from different systems needs to be achieved. With ongoing advances in the accuracy of sensing techniques and improvement of modelling approaches, this challenge might be achievable.

Ketamine augmentation rapidly improves depression scores in inpatients with treatment-resistant bipolar depression

Objective: To study the clinical effect of a single ketamine infusion, 0.5 mg/kg body weight, in bipolar depressive patients receiving mood-stabilising drugs, not improving on antidepressants. Previously, in such patients, we had found a correlation between clinical efficacy, serum brain-derived neurotrophic factor and vitamin B12 levels and a rapid improvement in neurocognitive performance.Methods: The study included 53 patients (13 men, 40 women), aged 22–81 years, receiving ≥1 mood-stabilising medications of the first and/or second generation. Pre-infusion depression intensity on the Hamilton Depression Rating Scale (HDRS) was 23.4 ± 4.6 points and the assumed criterion for response was a reduction of ≥50% in the HDRS score after 7 days.Results: Twenty-seven subjects (51%) met a criterion for response, more frequently males (77%) than females (43%). Responders did not differ from non-responders as to age, illness onset, duration of depressive episode, type of bipolar illness, family history of psychiatric illness, personal/family history of alcoholism or using lithium, quetiapine or a combination of these mood stabilisers.Conclusions: The results confirm a rapid antidepressant effect of ketamine infusion in a considerable proportion of those patients with bipolar depression receiving mood-stabilising drugs. Apart from male gender, no other clinical factors were predictors of response.

A retrospective study of late-onset bipolar disorder: A comparison with early and intermediate onset

Aim: To evaluate the sociodemographic, clinical, and treatment characteristics profile of late-onset (LO) bipolar affective disorder (BPAD) (onset ≥50 years) and compare the patients with LO BPAD with early age of onset (10–25 years) and intermediate age of onset (26–40 years) BPAD for the demographic features, illness characteristics, and treatment characteristics. Methodology: In this retrospective study, data (demographic features, clinical characteristics, and treatment characteristics) of 115 patients with LO BPAD (onset ≥50 years) were extracted and were compared with 93 patients with intermediate-onset (IO) (26–40 years) and 130 patients with early-onset (EO) (10–25 years) BPAD groups. Results: Patients with LO BPAD differ from EO and IO BPAD in having higher rates of family history of mental disorders, higher rates of comorbid psychiatric disorders (especially substance use disorders) and physical illnesses, higher rates of suicidal ideations, lower rates of suicidal attempts, higher rates of Type-II BPAD, lower prevalence of psychotic symptoms during the episodes, shorter interepisodic duration, higher use of combination of mood stabilizers and antidepressants, lower preference of lithium, higher preference for valproate, and lower use of benzodiazepines. In addition, patients with LO BPAD differed from those with EO BPAD in having higher rates of having a depressive-manic illness pattern, longer duration of depressive episodes, and lower number of manic episodes. Patients with LO BPAD differed significantly from IO BPAD in having lower number of episodes and more often use of antipsychotic monotherapy during the acute phase. Conclusions: LO BPAD differs from IO and EO BPAD on several of the clinical characteristics. Treatment preferences by the clinicians for LO BPAD also differ from EO and IO BPAD.

Stigma and its correlates among patients with bipolar disorder: A study from a tertiary care hospital of North India

This study aimed to assess stigma and its sociodemographic and clinical correlates among patients with bipolar disorder while in remission. 185 patients currently in remission were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma, Explanatory Model Interview Catalogue Stigma Scale for perceived stigma and Participation scale for restriction of activities. About 28% patients reported moderate to high level of self stigma as assessed by ISMIS total score. Discrimination experience (38.9%) was reported to be the most commonly experienced self stigma followed by alienation (28.6%) and social withdrawal (28.6%). On the participation scale, about two-fifth (42%) of the participants had severe restriction of activities. Internalized stigma was higher among those with lower age and lesser income. Higher level of stigma was associated with shorter mean duration of remission, income, mean duration of depressive episodes, higher severity of residual depressive symptoms and current level of functioning. Higher internalized stigma was associated with greater restriction in participation of activities. To conclude, present study suggests that self stigma is highly prevalent among patients with bipolar disorder in India and is associated with clinical variables like duration of depressive episodes and level of functioning.

Duration of the depressive episode is correlated with ganglion cell inner plexifrom layer and nasal retinal fiber layer thicknesses: Optical coherence tomography findings in major depression

Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nerve fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not different from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.

Longer depressive episode duration negatively influences HF-rTMS treatment response: a cerebellar metabolic deficiency?

Repetitive transcranial magnetic stimulation (rTMS) is an evidence based neurostimulation modality used to treat patients with Major Depressive Disorder (MDD). In spite that the duration of current a depressive episode has been put forward as a negative predictor for clinical outcome, little is known about the underlying neurobiological mechanisms of this phenomenon. To address this important issue, in a sample of 43 melancholic stage III treatment resistant antidepressant-free refractory MDD patients, we reanalysed regional cerebral glucose metabolism (CMRglc) before high frequency (HF)-rTMS treatment, applied to the left dorsolateral prefrontal cortex (DLPFC). Besides that a lower baseline cerebellar metabolic activity indicated negative clinical response, a longer duration of the depressive episode was a negative indicator for recovery and negatively influenced cerebellar CMRglc. This exploratory 18FDG PET study is the first to demonstrate that the clinical response of HF-rTMS treatment in TRD patients may depend on the metabolic state of the cerebellum. Our observations could imply that for left DLPFC HF-rTMS non-responders other brain localisations for stimulation, more specifically the cerebellum, may be warranted.

Response style and severity and chronicity of depressive disorders in primary health care

BackgroundResponse styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study. MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43). ResultsAt five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r=0.54), Beck Depression Inventory (r=0.61), Beck Anxiety Inventory (r=0.50), Beck Hopelessness Scale (r=0.51) and Neuroticism (r=0.58). Rumination correlated also with proportion of follow-up time spent depressed (r=0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes. ConclusionsAmong primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

Motivational deficits in major depressive disorder: Cross-sectional and longitudinal relationships with functional impairment and subjective well-being

BackgroundMany individuals with major depressive disorder present with prominent motivational deficits; however, the effect of these symptoms on functional outcomes in the illness remains unclear. MethodIndividuals with major depression who participated in the Sequenced Treatment Alternatives to Relieve Depression study were included in the present investigation (N=1563). Motivational deficits were evaluated using a derived measure from the Hamilton Depression Rating Scale, while functioning was assessed using the Work and Social Adjustment Scale. Subjective outcomes were also evaluated using the Quality of Life Enjoyment and Satisfaction Questionnaire. ResultsAfter treatment with citalopram, over 70% of participants continued to experience some degree of motivational deficits. These deficits were significantly associated with greater functional impairments both globally and in each domain of functioning evaluated. These symptoms were also linked to worse subjective outcomes such as overall life satisfaction and quality of life. Change in the severity of motivational deficits over time was significantly linked with changes in outcome. Motivational deficits continued to demonstrate a significant association with outcomes, even after controlling for potentially confounding variables such as duration of depressive episode and severity of other depressive symptoms. ConclusionsMotivational deficits are significantly linked to the functional impairment present in many people with major depression, just as they are in other psychiatric illnesses such as schizophrenia. A greater understanding of the underlying mechanisms of these motivational deficits in particular, beyond other depressive symptoms, is critical to the development of strategies aimed at enhancing functional recovery and improved subjective well-being.

Response of depression to electroconvulsive therapy: a meta-analysis of clinical predictors.

Roughly one-third of individuals with depression do not respond to electroconvulsive therapy (ECT). Reliable predictors of ECT response would be useful for patient selection, but have not been demonstrated definitively. We used meta-analysis to measure effect sizes for a series of clinical predictors of ECT response in depression. PubMed was searched systematically to identify studies published after 1980 that tested at least 1 clinical predictor of response to ECT. Of 51 studies identified, 32 were compatible with meta-analysis. The weighted mean odds ratio (OR) or standardized mean difference (SMD) was computed for each of 10 clinical predictors, based on dichotomous outcomes (responder vs nonresponder). Statistical analyses examined robustness, bias, and heterogeneity. Shorter depressive episode duration predicted higher ECT response rate (SMD = -0.37, 7 studies, 702 subjects, P = 4 × 10(-6)). History of medication failure in the current episode was also a robust predictor: response rates were 58% and 70%, respectively, for those with and without medication failure (OR = 0.56, 11 studies, 1,175 subjects, P = 1 × 10(-5)). Greater age and psychotic features were weakly associated with higher ECT response rates, but heterogeneity was notable. Bipolar diagnosis, sex, age at onset, and number of previous episodes were not significant predictors. Analyses of symptom severity and melancholic features were inconclusive due to study heterogeneity. Longer depressive episodes and medication failure at baseline are robust predictors of poor response to ECT, with effect sizes that are modest but clinically relevant. Patient characteristics used traditionally such as age, psychosis, and melancholic features are less likely to be clinically useful. More robust clinical and biological predictors are needed for management of depressed patients considering ECT.

Determinants of Treatment-Resistant Depression: The Salience of Benzodiazepines.

Treatment-resistant depression (TRD) lacks consensus regarding its definition, despite being common in clinical practice. This study was designed to identify factors contributing to TRD in patients diagnosed with a major depressive disorder. Patients were grouped into "low," "medium," and "high" treatment-resistant (TR) groups based on the number of medications that had been prescribed for their depression. We identified a number of factors linked to TRD. The high TR group was generally older, had a longer depressive episode duration, a higher number of comorbid medical and anxiety disorders, a lower education, and were less likely to be in full-time employment. They also reported less trait irritability and were more likely to view medication as being a contributor to their current depression. Some differences between non-melancholic and melancholic subsets were evident and point to the benefits in research on TRD analyzing the two diagnostic groups separately. The most striking finding was benzodiazepine use, which was significantly more common in the high TR group and within both the melancholic and non-melancholic subsets. Some potential explanations for this finding are offered.

Sexual Dysfunction in Depressive Women

Introduction Mental illness has a large effect on sexual function and the expression of sexuality. Many studies have illustrated that sexual dysfunction is significantly associated with depression. Objectifs Assess the quality of sexual response in a population of depressed women. Search factors associated with impaired sexual function. Aims Investigate the degree of correlation between sexual dysfunction and depression. Methodes Analytical and descriptive Study involving 30 sexually active women seen for the first time at the Razi hospital. They presents a first major depressive episode according to DSM IV. Exclusion criteria were the presence of psychotic symptoms, the use of antidepressants in the last three months and inflammatory or neoplastic comorbidity. The severity of depression was assessed by the Beck Depression Scale. The evaluation of sexuality was made ??by Aziona sexual experience scale Results The middle-age was 37 years, 80% were married. Depression was severe in 60% of cases and the average time of care was 3.7 months. Sexual function was altered in 70% of cases with a positive correlation between the severity of depression, the depressive episode duration, and the sexual dysfunction. Sexual desire was the most affected by depression, distorted in more than half of patients. Sexual arousal and vaginal lubrication were also altered in respectively 40% and 36.7% of cases, while orgasm and satisfaction with orgasm were more conserved. Conclusion Taking into account the dimension of sexuality is important in the management of a depressive episode. Early treatment is a protective factor from sexual dysfunction in depressed women.

Mechanisms underlying neurocognitive dysfunctions in recurrent major depression.

Recent work shows that depression is intimately associated with changes in cognitive functioning, including memory, attention, verbal fluency, and other aspects of higher-order cognitive processing. Changes in cognitive functioning are more likely to occur when depressive episodes are recurrent and to abate to some degree during periods of remission. However, with accumulating frequency and duration of depressive episodes, cognitive deficits can become enduring, being evident even when mood improves. Such changes in cognitive functioning give depression links to mild cognitive impairment and thereby with neurodegenerative conditions, including Alzheimer’s disease, Parkinson’s disease, schizophrenia, and multiple sclerosis. Depression may then be conceptualized on a dimension of depression – mild cognitive impairment – dementia. The biological underpinnings of depression have substantial overlaps with those of neurodegenerative conditions, including reduced neurogenesis, increased apoptosis, reactive oxygen species, tryptophan catabolites, autoimmunity, and immune-inflammatory processes, as well as decreased antioxidant defenses. These evolving changes over the course of depressive episodes drive the association of depression with neurodegenerative conditions. As such, the changes in cognitive functioning in depression have important consequences for the treatment of depression and in reconceptualizing the role of depression in wider neuroprogressive conditions. Here we review the data on changes in cognitive functioning in recurrent major depression and their association with other central conditions.

State rumination enhances elaborative processing of negative material as evidenced by the late positive potential.

Rumination has been shown to increase negative affect and is highly associated with increased duration of depressive episodes. Previous research has shown that enhanced elaborative processing of negative stimuli is often associated with depression and trait rumination. We hypothesized that engaging in rumination would result in sustained elaborative processing of negative information, as measured by late positive potential (LPP) asymmetry, regardless of depression. Participants were experimentally induced to engage in ruminative- or distraction-oriented thoughts and subsequently viewed negative, positive, and neutral images. Our results showed a very specific right-dominant frontal and parietal LPP to negative, but not neutral or positive, pictures in the rumination condition only that was not correlated with any measures of trait rumination or depression symptoms. This suggests that state rumination alone may lead to an enhanced, sustained processing of negative material that is typically associated with depression. (PsycINFO Database Record

Psychomotor retardation is a scar of past depressive episodes, revealed by simple cognitive tests

The cumulative duration of depressive episodes, and their repetition, has a detrimental effect on depression recurrence rates and the chances of antidepressant response, and even increases the risk of dementia, raising the possibility that depressive episodes could be neurotoxic. Psychomotor retardation could constitute a marker of this negative burden of past depressive episodes, with conflicting findings according to the use of clinical versus cognitive assessments. We assessed the role of the Retardation Depressive Scale (filled in by the clinician) and the time required to perform the neurocognitive d2 attention test and the Trail Making Test (performed by patients) in a sample of 2048 depressed outpatients, before and after 6 to 8 weeks of treatment with agomelatine. From this sample, 1140 patients performed the TMT-A and -B, and 508 performed the d2 test, at baseline and after treatment. At baseline, we found that with more past depressive episodes patients had more severe clinical level of psychomotor retardation, and that they needed more time to perform both d2 and TMT. When the analyses were performed again after treatment, and especially when the analyses were restricted to patients with clinical remission, the cognitive tests were the only ones correlated with past depressive episodes. Psychomotor retardation tested at a cognitive level was therefore systematically revealing the burden of past depressive episodes, with an increased weight for patients with less remaining symptoms. If prospectively confirmed, interventions such as cognitive remediation therapy could benefit from a more specific focus on neurocognitive retardation.

Deep Brain Stimulation in Major Depression: Plastic Changes of 5-Hydroxytryptamine Neurons

Major depressive disorder (MDD) is a severe psychiatric syndrome with a very high socioeconomic impact. The high cost of MDD is attributable to its large incidence in the general population (lifetime prevalence is close to 20%); the long duration of depressive episodes; and emergence of depressive episodes during active periods of adult life, which results in very large labor costs. The large and increasing impact of MDD is not paralleled by marked improvements in its treatment. The antidepressant market is dominated by drugs targeting the monoamine systems, such as selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, which are pharmacologic refinements of tricyclic antidepressant drugs, which were discovered serendipitously in the 1950s. Selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors have increased treatment compliance because of the absence of severe side effects. However, their speed and efficacy are suboptimal, leaving a large percentage of patients with partial or incomplete responses after several months of treatment. Many patients are refractory to numerous pharmacologic treatments and require nonstandard interventions to improve their quality of life and reduce suicide risk. Antidepressant-like Effects of Cortical Deep Brain Stimulation Coincide With Pro-neuroplastic Adaptations of Serotonin SystemsBiological PsychiatryVol. 76Issue 3PreviewCortical deep brain stimulation (DBS) is a promising therapeutic option for treatment-refractory depression, but its mode of action remains enigmatic. Serotonin (5-HT) systems are engaged indirectly by ventromedial prefrontal cortex (vmPFC) DBS. Resulting neuroplastic changes in 5-HT systems could thus coincide with the long-term therapeutic activity of vmPFC DBS. Full-Text PDF ErratumBiological PsychiatryVol. 76Issue 5PreviewErratum to: “Deep Brain Stimulation in Major Depression: Plastic Changes of 5-Hydroxytryptamine Neurons” by Artigas which appeared in Biological Psychiatry (2014;76:174-175). On page 175, column 1, 8th line from the bottom, the findings were inadvertently misstated as a decrease rather than an increase. The full corrected sentence is: “Using this procedure, the authors found that CSDS induced a robust and significant increase of the density of 5-HT nerve endings in various forebrain areas, including the vmPFC, the basolateral amygdala, and the dentate gyrus of the hippocampal formation, which was normalized after long-term DBS treatment.” Full-Text PDF