Effective Treatment For Depression Research Articles

Electroconvulsive therapy-specific volume changes in nuclei of the amygdala and their relationship to long-term anxiety improvement in depression.

Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. ECT induces volume changes in the amygdala, a key center of anxiety. However, the clinical relevance of ECT-induced changes in amygdala volume remains uncertain. We hypothesized that nuclei-specific amygdala volumes and anxiety symptoms in depression could explain the clinical correlates of ECT-induced volume changes. To test this hypothesis, we enrolled patients with depression who underwent ECT (N = 20) in this multicenter observational study and collected MRI data at three time points: before and after treatment and a 6-month follow-up. Patients who received medication (N = 52), cognitive behavioral therapy (N = 63), or transcranial magnetic stimulation (N = 20), and healthy participants (N = 147) were included for comparison. Amygdala nuclei were identified using FreeSurfer and clustered into three subdivisions to enhance reliability and interpretability. Anxiety symptoms were quantified using the anxiety factor scores derived from the Hamilton Depression Rating Scale. Before treatment, basolateral and basomedial subdivisions of the right amygdala were smaller than those of healthy controls. The volumes of the amygdala subdivisions increased after ECT and decreased during the follow-up period, but the volumes at 6-month follow-up were larger than those observed before treatment. These volume changes were specific to ECT. Long-term volume changes in the right basomedial amygdala correlated with improvements in anxiety symptoms. Baseline volumes in the right basolateral amygdala correlated with long-term improvements in anxiety symptoms. These findings demonstrate that clinical correlates of ECT-induced amygdala volume changes are existent, but in a nucleus and symptom-specific manner.

A randomised controlled feasibility trial of Behavioural activation as a treatment for people with diabetes and depression: (DiaDeM feasibility trial).

There is a lack of evidence on effective treatments for depression in people with T2DM, particularly in Low and Middle-Income Countries (LMICs). This study aims to test the feasibility and acceptability of a culturally adapted Behavioural Activation (BA) intervention (DiaDeM) for people with depression and T2DM in two South Asian LMICs. A multicountry, individually randomised-controlled feasibility trial was conducted from March 2022 to November 2022. We recruited adults from diabetes healthcare facilities in Bangladesh and Pakistan with a diagnosis of depression and T2DM. Consenting individuals were randomised to either optimised usual care or the DiaDeM intervention, which comprised six BA sessions delivered by non-mental health facilitators over six to twelve weeks. Participants were followed up at three and six months post-randomisation. The feasibility and acceptability of recruitment and retention, intervention delivery, and data collection were assessed. A mixed-methods process evaluation was also performed to inform the main trial. The DiaDeM feasibility trial successfully recruited 128 participants, with 85 % retention at six months follow-up. The majority of participants engaged with the intervention, demonstrating good adherence to the Behavioural Activation (BA) sessions. Data completeness for key outcomes, including depression severity and HbA1c levels, was high across all time points (>90 %). The process evaluation showed high acceptability of the intervention, with participants reporting increased motivation and improved management of both T2DM and depression. Good recruitment and retention rates, completeness of data collection, and high acceptability of the intervention showed that it would be feasible to undertake a full-scale trial.

Who is at risk of long-term subjective memory impairment after electroconvulsive therapy?

Electroconvulsive therapy (ECT) is an effective treatment for depression with potential transient cognitive side effects. However, subjective memory impairment can extend over a long period after ECT. This study aimed to assess potential risk factors for long-term subjective memory impairment 6 months after ECT and to explore if the associations are mediated by depressive symptoms. This registry-based study used the Swedish National Quality Register for ECT and other national registers. Long-term subjective memory worsening was defined as a minimum 2-step worsening on the memory item from the comprehensive psychopathological rating scale (CPRS-M) from before ECT to 6 months after ECT. Changes on the scale were also analyzed in continuous models. Statistical methods used were logistic regression and linear regression analyses in univariable and multivariable models. The study population consisted of 1498 patients. Subjective memory worsening occurred in 25.2 % of the population. Long-term subjective memory worsening was associated with more depressive symptoms and lower education levels. No association could be found related to ECT technical factors. The associations between age and psychiatric comorbidities with subjective memory worsening were mediated by depressive symptoms. Patients can be informed that depressive symptoms are one of the biggest contributing factors to long-term subjective memory impairment after ECT. A successful treatment is therefore important to minimize the long-term experience of memory deficits. The number of sessions or ECT technical factors do not seem to be associated with long-term subjective memory impairment.

Exploring the contribution of the dopaminergic and noradrenergic systems in the antidepressant-like action of 1-(2-(4-(4-ethylphenyl)-1H-1,2,3-triazol-1-yl)phenyl)ethanone in mice.

1-(2-(4-(4-ethylphenyl)-1H-1,2,3-triazol-1-yl)phenyl)ethanone (ETAP) is a novel hybrid compound containing 1,2,3-triazole and acetophenone. It exhibits antidepressant-like effects in male mice, linked to modulation of serotonergic receptors and monoamine oxidase A (MAO-A) inhibition. This study aimed to evaluate the involvement of the dopaminergic and noradrenergic systems, as well as MAO-B activity inhibition, in the antidepressant-like effect of ETAP in male mice, and to evaluate the antidepressant-like effect of ETAP in female mice. Male mice were treated with different dopaminergic and noradrenergic receptors antagonists 15min before administering ETAP (1mg/kg, intragastrically, i.g.). The tail suspension test (TST) was performed 30minutes later. Different male mice were treated with ETAP (1mg/kg, i.g.), and 30minutes later, were euthanized to assess MAO-B activity in the prefrontal cortex and hippocampus. To evaluate the antidepressant-like of ETAP in female mice, ETAP (1mg/kg, i.g.) was administered, followed by the TST and the forced swimming test (FST) 30minutes later. The dopaminergic antagonists haloperidol (0.05mg/kg, intraperitoneally, i.p.), SCH23390 (0.01mg/kg, subcutaneously, s.c.), and sulpiride (50mg/kg, i.p.), as well the noradrenergic antagonists prazosin (1mg/kg, i.p.), yohimbine (1mg/kg, i.p.), and propranolol (2mg/kg, i.p.), prevented the antidepressant-like effect of ETAP in the TST. MAO-B activity was unaffected by ETAP in both the prefrontal cortex and hippocampus. ETAP (1mg/kg, i.g.) induced a significant antidepressant-like effect in female mice in the TST and FST. These findings provide valuable insights into the antidepressant-like effect of ETAP, highlighting its potential for developing more effective depression treatments.

Early Detection Depression Based On Action Unit and Eye Gaze Features Using a Multi-Input CNN-WoPL Framework

Depression is a common mental disorder with significant life impact, including a high risk of suicide. Patients with depression attempt suicide five times more often than the general population. Self-reporting, subjective judgement and clinician expertise influence conventional diagnostic methods. For timely intervention and effective treatment, early and accurate diagnosis of depression is essential. This study proposes a framework called Multi-Input CNN-WoPL, a CNN-based method without a pooling layer that combines two features - action units and gaze - to improve accuracy and robustness in automatic depression detection. Pooling layer reduces spatial dimension of feature map, resulting in loss of information related to expression data, affecting depression detection result. The performance of the proposed method results in an accuracy of 0.994 and F1 score = 0.993, the F1 score value close to 1.0 indicates that the proposed method has good precision, recall and performance.

Exploring the effects of erythropoietin treatment on cortical thickness and hippocampal volume in patients with mood disorders undergoing electroconvulsive therapy: A randomized, placebo-controlled trial.

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, its utilization is limited to the most severely ill patients due to stigma, healthcare provider unfamiliarity, and concerns regarding cognitive side effects. Erythropoietin (EPO) is a promising add-on treatment during ECT due to its potential to increase neuroplasticity and cognition. To explore the effects of EPO administration on cortical thickness and hippocampal volumes. In a randomized, double-blinded, placebo-controlled trial, we previously investigated the impact of EPO (40,000 IU) versus placebo (saline) infusions on cognitive side effects of unipolar or bipolar depression patients undergoing eight ECT sessions over 2.5 weeks. This cross-sectional magnetic resonance imaging study explores the effect of EPO on cortical thickness and hippocampal volumes 3 days post-ECT in 37 of the EPO trial patients (EPO n = 21; placebo n = 16). Compared to the placebo group, EPO-treated patients displayed thicker cortex in distributed regions of the right hemisphere, predominantly in the parietal and occipital areas. There were no significant group differences in the hippocampal volumes or prefrontal cortex thickness. EPO treatment may produce a selective increase in the right-side occipito-parietal cortical thickness. In contrast, the thickness of other cognition-relevant structures was not significantly affected. This aligns with our previously reported finding that EPO has a selective effect on autobiographical memory and associated right-side parietal activity in the absence of changes in global cognition. It remains to be investigated whether longer EPO treatment and follow-up assessment may be necessary for overt structural changes in cognition-relevant brain networks.

Urban and Rural Differences in the Efficacy of a Mobile Health Depression Treatment for Young Adults

Depression among young adults represents a growing health problem in the U.S., but access to effective treatment remains a challenge. Mobile health (mHealth) approaches promise to deliver accessible and effective depression treatment; however, questions remain regarding how mHealth depression treatment efficacy may vary geographically based on urban and rural environmental contexts. The present study addresses this knowledge gap by leveraging data from a randomized clinical trial of an mHealth depression treatment called Cognitive Behavioral Therapy-text (CBT-txt) as applied to a sample of 103 U.S. young adults (ages 18–25). Prior research has demonstrated the efficacy of CBT-txt to reduce depressive symptoms. In the present study, we conduct an exploratory, post hoc analysis employing moderated growth curve modeling to investigate whether observed treatment efficacy differed between study participants residing in rural versus urban areas. The findings indicate that CBT-txt treatment effects in terms of reducing depression symptoms were significantly stronger for young adults residing in rural, as compared to urban, regions (β = 13.759, 95% CI = 0.796, 26.723, p < 0.038). We speculate that this is because of the lack of mental healthcare resources in rural, as compared to urban areas, as well as the greater level of environmental stressors, such as artificial light and noise, found in cities, which may mitigate treatment effects.

Saikosaponins from Bupleurum scorzonerifolium Willd. alleviates microglial pyroptosis in depression by binding and inhibiting P2X7 expression

BackgroundThe major depressive disorder (MDD) is a heterogeneous condition and characterized by a high recurrence rate, with neuroinflammation playing a significant role in its various potential pathologies. In recent years, neuronal pyroptosis induced by neuroinflammation has garnered increasing attention in depression research. Bupleurum scorzonerifolium Willd. is depression research in traditional Chinese medicine prescriptions to treat depression and exhibits notable anti-inflammatory properties. Saikosaponins (SSs) are the primary active components of Bupleurum scorzonerifolium Willd., although their mechanism of action in relation to anti-depressive effects remains unclear. PurposeThe purpose is to evaluate the efficacy of Chinese herbal medicine in treating depression through the lens of modern pharmacology. Additionally, it aims to explore the potential value of new mechanisms in the treatment of depression. Study design and methodsAn in vivo model of depression was established by intraperitoneal injection of LPS. HE staining, Nissl staining, and Golgi staining were used to evaluate the effectiveness of depression treatments in each group of mice. The activation of microglia was analyzed using immunofluorescence to evaluate the anti-inflammatory effects of drugs. In vitro models, N9 cells induced by LPS and ATP used CCK-8 assay, and lactate dehydrogenase assay were conducted to explore the therapeutic effect of the SSs. Western blot and immunohistochemical methods were employed to investigate the expression of P2X7 and apoptosis-related proteins. BzATP was introduced as a P2X7 agonist, and CETSA and CHX pulse-chase assay were utilized to verify the combined action and stability of the SSs with P2X7. Results57 triterpenoid saponin compounds were identified by Unifi in Bupleurum scorzonerifolium Willd. In both in vivo and in vitro models, the SSs has been shown to significantly improve depression-like behavior, reduce central inflammation, and significantly inhibit neuronal pyroptosis in mice. The SSs can significantly decrease the expression of P2X7 in the brains of depressed mice and enhance the stability of P2X7 protein in N9 cells. ConclusionSSs in Bupleurum scorzonerifolium Willd. bind and inhibit the P2X7 receptor to alleviate neuronal pyroptosis and improve symptoms of depression.

Concepts of Implied Interventions for Treating Depression: A Comprehensive Review

Hence, answering the question how a person is able to secure and maintain lifelong good mood would facilitate in deceiphering depression; a common and etiologically complex multi factorial mental health disorder which affects over 264 m individuals worldwide with tremendous effect on morbidity and economic burden. Here, our study results from more than 100 experimental and observational studies with respect to effective treatments for depression across three main groups such as: Pharmacological interventions, Psychotherapeutic approaches, and Emerging digital health solutions have been effective as implied interventions to tret Depression. While antidepressants, particularly selective serotonergic reuptake inhibitors (SSRIs), continued as the bedrock of therapy; Novel therapies with Ketamine have shown potential for treatment failure cases. Large-scale studies of Psychotherapeutic methods, such as Cognitive Behavioural Therapy (CBT) and Interpersonal Therapy (IPT), show high effectiveness rates in most populations. Digital health interventions, such as e-therapy, were potential alternatives and particularly suitable for patients in rural areas. Integrating these modalities will allow clinicians to offer more individualised and tailored care. This review provided an overview of the mechanisms of each intervention for depression as a clinical aid to inform decisions by clinicians as well as policy makers seeking to improve treatment pathways for individuals with Mood disorders and Depression.

Transcranial Direct Current Stimulation Combined With Repetitive Transcranial Magnetic Stimulation for Depression

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are both recognized as effective treatments for depression when applied individually. However, it is unknown whether rTMS combined with tDCS has better efficacy in the treatment of major depressive disorder (MDD). To investigate the clinical effectiveness and safety of rTMS, tDCS, tDCS + rTMS, and sham tDCS + sham rTMS after 2 weeks of treatment in patients with MDD. This double-blind, sham-controlled randomized clinical trial was conducted from November 2021 to April 2023 at 3 hospitals in China (Kangning Hospital affiliated with Ningbo University, Lishui Second People's Hospital, and Taizhou Second People's Hospital). Adult patients (aged 18-65 years) who were diagnosed with major depressive disorder were recruited. Participants were randomly assigned to 1 of 4 interventions: active tDCS + active rTMS, sham tDCS + active rTMS, active tDCS + sham rTMS, and sham tDCS + sham rTMS. Data analysis followed an intention-to-treat approach. Patients received a 2-week course of treatment. The tDCS was administered using a 2-mA direct current stimulator with electrodes placed on the left and right dorsolateral prefrontal cortex (DLPFC). Each tDCS session lasted 20 minutes and was conducted 30 to 60 minutes prior to the rTMS session for a total of 10 sessions. The rTMS was delivered at a frequency of 10 Hz using a figure-8 coil placed on the left DLPFC, with each session consisting of 1600 pulses. Treatments were administered 5 times per week for 2 weeks. Sham treatments were performed with a pseudostimulation coil and emitted only sound. The primary outcome was the change in total score from baseline to week 2 on the 24-item Hamilton Depression Rating Scale (HDRS-24; score range: 0-52, with the highest score indicating more severe symptoms). A total of 240 participants (139 females [57.9%]; mean [SD] age, 32.50 [15.18] years) were included. As a primary outcome, patients who received active tDCS + active rTMS showed a significantly greater reduction in mean (SD) HDRS-24 total scores compared with patients in the other 3 groups (active tDCS + active rTMS: 18.33 [5.39], sham tDCS + active rTMS: 14.86 [5.59], active tDCS + sham rTMS: 9.21 [4.61], and sham tDCS + sham rTMS: 10.77 [5.67]; F3,236 = 35.79; η2 = 0.31 [95% CI, 0.21-0.39]; P < .001). This trial found that tDCS + rTMS was a more effective and safe treatment option than either the tDCS or rTMS intervention alone for patients with MDD. China Clinical Trial Registry Identifier ChiCTR2100052122.

Self-Rated ECT Outcomes in Patients With Depression: A Naturalistic Single-Site Study.

Electroconvulsive therapy (ECT) is considered to be the most effective treatment for severe depression. This study investigated recent ECT outcomes for depression at a large tertiary center, which also provides community care. Data were obtained from Mayo Clinic Rochester patients ages 18 and older who received an acute course of ECT between August 1, 2017 and April 30, 2024. Patients were included if there was a depressive disorder diagnosis (unipolar or bipolar) and a self-rated Patient Health Questionnaire-9 (PHQ-9) within 10 days of the start and end of the acute course. Patients were excluded if the starting PHQ-9 score was less than 10. The age, sex, number of acute course treatments, stimulus electrode lead placement, and PHQ-9 scores were collected. Response (PHQ-9 improvement ≥50%) and remission (PHQ-9 < 5) rates were calculated. Linear and logistic regressions were performed to investigate predictors of response and remission. Of 1206 patients identified, 408 met final inclusion and exclusion criteria. The response rate was 80.4%, and remission rate was 52.7%. Logistic regression for response showed no significant predictors; the P value for age just missed statistical significance (odds ratio, 1.0152; 95% confidence interval, 0.9991-1.0316; P = 0.0641). Logistic regression for remission showed only a lower baseline PHQ-9 score (odds ratio, 0.9465; 95% confidence interval, 0.9049-0.9891; P = 0.0152) as a significant predictor. Our results affirmed the high efficacy of ECT in severe depression. No other established treatment for depression can report a response rate as high as 80% in a naturalistic study. This study supports the continued relevance and place of ECT for severe depression.

Running therapy or antidepressants as treatments for immunometabolic depression in patients with depressive and anxiety disorders: A secondary analysis of the MOTAR study

BackgroundExercise promotes immunometabolic health and is increasingly recognized as an effective depression treatment. Exercise may be beneficial for patients with immunometabolic depression (IMD), who experience inflammatory and metabolic dysregulations and may respond less to antidepressants. This secondary analysis of the MOTAR study compared the effects of running therapy and antidepressants on IMD features among patients with depression and/or anxiety disorder. We additionally assessed whether baseline IMD moderated intervention effects on depression. MethodsParticipants received 16 weeks of group-based running therapy (N = 96) or escitalopram/sertraline (N = 45) in a partially randomized patient preference design. IMD features included atypical, energy-related symptom (AES) severity, inflammation index (CRP, IFN-γ, IL-6, TNF-α), metabolic syndrome index, three metabolite principle components (PC) (derived from 73 metabolites) and a composite IMD index. ResultsInterventions differed in changes in the metabolic syndrome index (d = 0.59, p = 0.026) and IMD index (d = 0.85, p < 0.001). While running therapy decreased both outcomes, the antidepressant group showed an increased IMD index. Although groups did not differ statistically significant in changes in AES severity, inflammation index, and metabolite PC1, results indicated a consistent trend towards greater improvement with running therapy across these outcomes as well (d = 0.38 to 0.52). Baseline IMD did not moderate intervention effects on depression outcomes. ConclusionsThis study suggests that exercise more effectively targets the IMD dimension than antidepressants. Patients with IMD did not benefit more from running therapy than antidepressants in terms of reductions in depression. Exercise should be considered an alternative or complementary treatment to particularly reduce IMD features in depressed patients. Trial registrationTrialregister.nl Number of identification: NTR3460.

Distinct prefrontal cortex alterations in confirmed and suspected depression individuals with different perceived stress during an emotional autobiographical memory task: One fNIRS investigation

BackgroundPrevious research showed that perceived stress was strongly linked to depression, little is known about the underlying neurological mechanism of different depression subtypes with different perceived stress, and there is currently no classification of stress-based subtypes of depression. This study aimed at using fNIRS to uncover the neuromechanism of confirmed and suspected depression with different perceived stress, hence providing neurobiological evidence for the classification of stress-based depression subtypes. It is a significant target for effective depression treatment. MethodThe study included 551 young adults: 256 healthy control individuals, 62 confirmed depression patients, and 233 suspected depression participants. A 53-channel fNIRS imaging system was used to gather the average oxyhemoglobin level in the PFC during EAMT. ResultsCompared with HC, confirmed and suspected depression group show significant lower hemodynamic activation in right frontal lobe of frame under high loss of control. Confirmed depression with high sense of tension had higher activation than with high loss of control in right dlPFC, while for suspected depression, the activation with high sense of tension was lower than with high loss of control in left broca's area (BA) and front polar cortex (FPC). ConclusionAll perceived stresses were not equal in their impacts on different depression types. The confirmed and suspected depression were two different depression subtypes sharing distinct activation pattern under different perceived stress in PFC, which may be an important target for stress-linked psychopathology. Depression can be further classified precisely based on stress. fNIRS can provide neuroimaging evidence for classification of stress-based depression subtypes.

Assessing the impact of immersive virtual reality technology on the psychological recovery of patients with Parkinson’s disease depression: study protocol of a randomized controlled trial

Background and aimDepression in Parkinson’s disease (DPD) has a high incidence rate among patients with Parkinson’s disease (PD). It is a common nonmotor symptom of PD that seriously affects the quality of life of patients. Thus, improving DPD is important for improving the quality of life of patients. Psychotherapy for depression is limited for many reasons, and only a few patients are able to benefit from this therapy. Several studies have demonstrated that relaxation therapy, playing, and exercise therapy are effective treatments for depression. In recent years, virtual reality (VR) has rapidly developed as a form of rehabilitation due to its immersive characteristics and accessibility. It has also been applied in the psychological treatment of phobia and anxiety. However, no relevant research on the treatment of DPD has been conducted using VR. This study aims to assess the effects of immersive VR-assisted training on patients with DPD.MethodsThis single-blind randomized controlled trial will recruit 74 patients with DPD. The patients will then be randomly allocated into two groups. The patients in the VR group (n = 37) will receive VR-assisted training (40 min) three times a week for 8 weeks. The patients in the non-VR training group (n = 37) will receive treatment as usual. The outcome measures will be assessed before intervention, and after 8 weeks, 3 months, and 6 months of the intervention. The primary outcomes will include the Hamilton Depression Scale-24. The secondary outcomes will include the 36-Item Short-Form Health Survey questionnaire, neuroinflammation factors (brain-derived neurotrophic factor, interleukin-6, and C-reactive protein), and functional magnetic resonance imaging.DiscussionThe traditional treatment of depression has limited resources and requires a lot of time and energy. It is not suitable for patients with PD having mobility difficulties and residing in remote areas. VR can make up for limitations in traditional treatment methods. An advantage of VR is that it makes patients more invested in active participation. This study may provide an improved method for the clinical treatment of patients with DPD, which is suitable for clinical decision-making and future practice.Trial registrationThe study has been registered in the Chinese Clinical Trial Registry ChiCTR2200065843, November 16, 2022.https://www.chictr.org.cn/showproj.html?proj=174551{2a and 2b}

Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report

IntroductionPerinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.Case presentationA 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.ConclusionTo our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

Flavonoids against depression: a comprehensive review of literature.

Depression is a state of low mood and aversion to activity, which affects a person's thoughts, behavior, motivation, feelings, and sense of wellbeing. Pharmacologic therapies are still the best effective treatment of depression. Still, most antidepressant drugs have low efficacy and delayed onset of therapeutic action, have different side effects, and even exacerbate depression. Such conditions make it possible to look for alternatives. Consequently, we decided to summarize the impact of flavonoids on depression in this review. We searched scientific databases such as SCOPUS, PubMed, and Google Scholar to find relevant studies until July 2022. A wide variety of natural components have been shown to alleviate depression, one of which is flavonoids. Due to the growing tendency to use natural antidepressant drugs, scientific studies are increasingly being conducted on flavonoids. This study aims to review the latest scientific researches that indicate the antidepressant potential of flavonoids. Various mechanisms include neurotransmitter system modulation and dopaminergic, noradrenergic, and serotonergic pathways regulation in the central nervous system. Different compounds of flavonoids have antidepressant properties in vivo or in vitro experiments or clinical trials and can be used as alternative and complementary treatments for depression. In general, it was observed that there were no severe side effects. Our study proves the antidepressant potential of flavonoids, and considering the limited side effects, they can be used as complementary medicine for depressed patients.

The impact of sleep disturbances on treatment efficacy and prognosis in patients with depressive and anxiety disorders.

Little was known about the relationship between sleep disturbances and depressive and anxiety disorders, as well as the efficacy of treatment regimens. During 2021 to 2023, a total of 417 participants were screened by Hamilton Depression Rating Scale (HAMD-17) and Hamilton Anxiety Rating Scale (HAMA-14) for psychological status, and Pittsburgh sleep quality index (PSQI) assessment. 409 participants were finally enrolled, of which 188 (45.97%) were suffered from sleep disorders. All participants were received polysomnography (PSG) followed by six-week pharmacological treatment of escitalopram and zopiclone, and finally assessed by HAMD-17 and HAMA-14 for treatment efficacy. PSG monitoring indicated that participants with depression experienced prolonged rapid eye movement sleep latency (REMSL) and increased wakefulness after sleep onset (WASO) (P=0.030 and P=0.002, respectively). Those with anxiety disorders demonstrated a significantly higher percentage of non-rapid eye movement sleep (NREM%) and reduced WASO (P=0.013 and P=0.001, respectively). After six-weeks pharmacological treatment, participants with or without sleep disorders exhibited with similar efficacy outcomes of depression and anxiety disorders (P>0.05). However, every point of PSQI increment at baseline would decrease 0.78 and 0.85 times of probability of effective pharmacological treatment of depression and anxiety disorders. Moreover, participants with both effective outcomes of depression and anxiety disorders were found significant shorter sleep onset latency (SOL) (P<0.001). The insights gained underscore the necessity of considering sleep disturbances in enhancing the overall effectiveness of pharmacological treatments for depression and anxiety disorders.

DepActive: study protocol for a randomised controlled multicentre trial of telephone-delivered behavioural activation for the treatment of depression in older adults in primary care

BackgroundDepression is common in older adults and is related to reduced quality of life and functional ability as well as increased mortality and morbidity. Current guidelines recommend psychological treatments for the treatment of depression in adults. Studies show that about 30% of older adults with depression in Sweden receive pharmacological treatment and about 3% receive psychological treatment. However, a majority receive no treatment at all. There is a need for effective and scalable psychological treatment options for older adults with depression in primary care. Behavioural activation is an extensively evaluated, effective, and relatively simple treatment for depression that can be delivered by health care professionals without comprehensive training in psychological treatment.MethodsWe will conduct a randomised controlled 2-armed parallel group multicentre trial comparing treatment as usual in primary care to a five-session telephone-delivered behavioural activation treatment as add on to treatment as usual. The current trial is open labelled. In all, 250 older adults (≥ 65 years) with depression will be recruited from primary healthcare centres in three Swedish regions. The primary outcome is depressive symptoms measured with the Montgomery Åsberg Depression Rating Scale – Self rating version (MADRS-S) after treatment and at 3- and 6-month follow-up. Secondary outcomes include depression diagnoses, activity level (self-rated and measured with accelerometer), and self-rated anxiety, daily functioning, quality of life, self-efficacy, and loneliness.DiscussionThere is a need for fully powered studies of brief behavioural activation for older adults with depression delivered by telephone in a primary care context. This study has the potential to improve first-line treatment of depression in older adults in primary care, consequently reducing morbidity and mortality within this population. Increasing the availability and accessibility to effective psychological treatment for depression in older adults is needed to meet future demographic changes.Trial registrationClinicalTrials.gov: NCT06284889. Registered February 28, 2024.

The Interplay Between Sleep Disorders and Depression Examining the Influence of Insomnia and Daytime Sleepiness on Mental Health

Introduction: Depression is one of the most common mental disorders, characterized by a wide range of symptoms, including sleep disturbances. Sleep, as a key component of mental health, plays a significant role in the development and treatment of depression. This study examines the impact of sleep, particularly insomnia and excessive sleepiness, on depressive disorders. Objective: The aim of this study is to analyze the relationship between sleep quality and the occurrence and progression of depression, with particular attention to the influence of antidepressant treatment on sleep quality. Materials and Methods: A literature review covering studies on the relationship between sleep disorders and depression, as well as the effectiveness of various therapeutic methods for treating these disorders, found on the PubMed and Google Scholar platforms. Conclusions: Sleep quality has a significant impact on the onset and severity of depressive symptoms. Appropriate treatment of sleep disorders can significantly improve the effectiveness of depression treatment and, in some cases, even prevent it. Early diagnosis and treatment of sleep disorders may be a key component in the prevention and treatment of depression.

Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES): protocol for a cluster-randomized type 3 hybrid effectiveness-implementation trial

BackgroundDepression is the most diagnosed mental health condition among people living with HIV. Collaborative care is an effective intervention for depression, typically delivered in primary care settings. The HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) clinical intervention involves a depression care team housed off-site that supports depression care delivery by HIV care providers. In a randomized controlled trial, HITIDES significantly improved depression symptoms for veterans living with HIV and delivered cost savings. However, no HIV clinics in the Veterans Health Administration (VHA) have implemented HITIDES; as such, it is unclear what implementation strategies are necessary to launch and sustain this intervention.MethodsThis hybrid type-3 effectiveness-implementation trial examines the implementation and effectiveness of HITIDES in 8 VHA HIV clinics randomly assigned to one of two implementation arms. Each arm uses a different implementation strategy package. Arm 1 includes an intervention operations guide; an on-site clinical champion who, with the help of a peer community of practice, will work with local clinicians and leadership to implement HITIDES at their site; and patient engagement in implementation tools. Arm 2 includes all strategies from Arm 1 with assistance from an external facilitator. The primary implementation outcomes is reach; secondary outcomes include adoption, implementation dose, depressive symptoms, and suicidal ideation. We will conduct a budget impact analysis of the implementation strategy packages. We hypothesize that Arm 2 will be associated with greater reach and adoption and that Arm 1 will be less costly.DiscussionPreliminary work identified implementation strategies acceptable to veterans living with HIV and HIV care providers; however, the effectiveness and cost of these strategies are unknown. While the depression care team can deliver services consistently with high quality, the ability of the depression care team to engage with HIV care providers at sites is unknown. Findings from this study will be used to inform selection of implementation strategies for a broad rollout to enhance depression and suicide care for people living with HIV.Trial registrationClinicalTrials.gov ID: NCT05901272, Registered 10 May 2023, https://clinicaltrials.gov/study/NCT05901272