Depressive Episodes In Patients Research Articles

Electroconvulsive therapy for adolescents with severe depressive episode and suicidality: retrospective comparison between responders and non-responders

BackgroundFor adolescents with major depression who exhibit suicidal tendencies, Electroconvulsive Therapy (ECT) is increasingly adopted in clinical practice. Yet, the precise mechanisms behind its effectiveness remain elusive, and studies on factors that influence treatment outcomes are scarce.MethodsIn this retrospective comparative study, we included all adolescent severe depressive episode patients with suicidal tendencies admitted to the Psychiatry Department of the First Affiliated Hospital of Chongqing Medical University between 2017 and 2021 and received ECT treatment. By collecting data on personal history, medical history, and standard treatment features, we established demographic, disease, medication, and ECT treatment factors variables. Patients were divided into effective and ineffective groups based on the Clinical Global Impressions-Improvement (CGI-I) scale scores, and differences between outcomes were compared. Logistic regression analyses were used to identify factors independently associated with ineffectiveness.ResultsA total of 494 adolescent severe depressive episode patients with suicidal behavior who received ECT were included in this study. According to CGI-I scores, the treatment was effective in 361 patients (73.1%) and ineffective in 133 patients (26.9%). Logistic regression analyses showed that 8 to 12 and 12 to 16 ECT sessions reduced the risk of ineffectiveness compared to fewer than 4 sessions. The risk of ineffectiveness decreased with age and increased with comorbidity with obsessive–compulsive disorder (OCD). Compared to sertraline, escitalopram was associated with a heightened risk of futility, whereas olanzapine and aripiprazole demonstrated a reduced risk when contrasted with quetiapine.ConclusionsECT's ineffectiveness in treating adolescent severe depressive episode with suicidal behavior decreases with age, and comorbidity with OCD significantly increases the risk of treatment failure. Fewer than 8 ECT sessions may hinder achieving satisfactory results.

OP63 Incorporating Machine Learning Methods In Health Economic Evaluations: A Case Study On Depression Prevention

IntroductionNew methodologies such as machine learning are becoming widely available and are increasingly used. However, more guidance on their role in the context of economic evaluations would be beneficial.MethodsWe developed a machine learning model to predict recurrent depressive episodes and incorporated the model outcomes in a health economic model to assess the cost effectiveness of offering targeted prevention of recurrent depression. We considered the impact on cost effectiveness (defined as cost per quality-adjusted life-year) for machine learning models with different thresholds for classifying a patient as being at risk, resulting in different precision-recall pairs.ResultsTargeted prevention of recurrent depression could enhance the cost effectiveness of depression treatment by preventing a small number of recurrent depressive episodes in patients where the estimated risk of recurrence is relatively high. More depressive episodes could be prevented with the trade-off of less cost effectiveness for the healthcare system.ConclusionsHealth economic modeling approaches can be augmented with machine learning methods, which broadens the areas in which evidence can be generated for policy makers to base their budget allocation. The precision of such predictive machine learning models must be high enough to be able to improve a care-as-usual healthcare system. Machine learning models generally let you set the level of precision acquired, at the cost of a possibly low recall, thereby limiting the impact on the healthcare system as a whole. More and better data for training these machine learning models will allow developed models to better distinguish patients who will and won’t develop a recurrent depressive episode, and for higher recall given a desired precision threshold. This will translate into a more substantial improvement in the treatment of depressive disorders in the healthcare system.

Serum Protein Profiling Reveals a Decrease in Apolipoprotein A-IV During a Clinical Depressive Mood State.

Depressive mood is a major psychiatric symptom that causes serious disturbances in daily life. Unlike physical symptoms, psychiatric symptoms are more difficult to evaluate objectively. Therefore, we aimed to discover biomarkers that reflect changes in serum protein metabolism during a clinical depressive mood. Serum protein profiling was conducted in participants who were not experiencing a current depressive episode (healthy individuals and patients in remission). Serum proteins were identified and quantified using liquid chromatography-tandem mass spectrometry. Differentially expressed proteins with a p-value <0.05 were selected, and candidate biomarkers were verified using multiple reaction monitoring analysis for absolute quantification. Apolipoprotein A-IV levels were lower in the group with a current episode of depression than in the remission and healthy control groups. Further, fibronectin levels were also lower in the group with a current episode of depression than in the healthy control group but not in the remission group. We found that apolipoprotein A-IV-mediated inflammation is involved in clinical depressive moods, possibly by inducing neurological changes in the brain. Therefore, apolipoprotein A-IV and fibronectin levels may be explored as potentially novel biomarkers for detecting a current episode of depression.

Borderline personality disorder and depression severity predict suicidal outcomes: A six-month prospective cohort study of depression, bipolar depression, and borderline personality disorder.

Suicide risk is high in patients with major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD). Whether risk levels of and risk factors for suicidal ideation (SI) and suicide attempts (SA) are similar or different in these disorders remains unclear, as few directly comparative studies exist. The relationship of short-term changes in depression severity and SI is underinvestigated, and might differ across groups, for example, between BPD and non-BPD patients. We followed, for 6 months, a cohort of treatment-seeking, major depressive episode (MDE) patients in psychiatric care (original n = 124), stratified into MDE/MDD, MDE/BD and MDE/BPD subcohorts. We examined risks of suicide-related outcomes and their risk factors prospectively. We examined the covariation of SI and depression over time with biweekly online modified Patient Health Questionnaire 9 surveys and analysed this relationship through multi-level modelling. Risk of SA in BPD (22.2%) was higher than non-BPD (4.23%) patients. In regression models, BPD severity was correlated with risk of SA and clinically significant SI. During follow-up, mean depression severity and changes in depression symptoms were associated with SI risk regardless of diagnosis. Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE. Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index.

IL-4 as a potential biomarker for differentiating major depressive disorder from bipolar depression.

We aimed to investigate the differential diagnosis of depressive episodes in patients with major depressive disorder (MDD) and bipolar disorder (BD) using peripheral blood cytokine expression levels. The levels of interleukin (IL)-2, IL-6, IL-10, IL-17, IL4, and IL-12; interferon (IFN)-γ; and tumor necrosis factor (TNF)-α were measured in patients with MDD and BD presenting acute episodes in an inpatient psychiatric setting. The expression levels of IL-6, IL-10, IL-17, and IFN-γ in the MDD and BD groups were higher than those in the control group (P < .05), but there was no significant difference between the patient groups and control group. Only the expression levels of TNF-α and IL-4 were higher in both groups than in the control group, and the BD group had higher levels than the MDD group (P < .05). The expression levels of IL-17, IFN-γ, IL-10, and IL-4 were significantly higher in BD-related manic episodes than in BD-related depressive episodes (P < .05). IL-6, IFN-γ, TNF-α, IL-10, and IL-4 levels were higher in BD-related depressive episodes than in MDD-related depressive episodes (P < .05). The receiver operating characteristic curve test for MDD and BD and the area under the curve for IL-4 revealed good clinical predictability. Patients with MDD and BD exhibited different cytokine profiles when experiencing acute episodes; patients with BD exhibited a more severe immune-inflammatory response system-compensatory immunoregulatory response system (CIRS) imbalance. IL-4 was found to have diagnostic value in differentiating between active depressive episodes in MDD and BD.

Relationship of insight to neurocognitive function and risk of recurrence in depression: A naturalistic follow-up study.

Major depressive disorder (MDD) is a highly recurrent mental illness accompanied by impairment of neurocognitive function. Lack of insight may affect patients' motivation to seek treatment, resulting in poor clinical outcomes. This study explores the relationship of insight to neurocognitive function and the risk of recurrence of depressive episodes in patients with MDD. Demographic, clinical variables, and neurocognitive function measured with Intra-Extra Dimensional Set Shift (IED) from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were collected from 277 patients with MDD. Among them, 141 participants completed a follow-up visit within 1-5 years. Insight was measured using the 17-item Hamilton Depression Rating Scale (HAM-D). To explore the factors associated with recurrence, binary logistic regression models were used. Patients with MDD, without insight, had significantly higher total and factor scores (anxiety/somatization, weight, retardation, and sleep) on the HAM-D and worse performance in the neurocognition task, compared to those with insight. Furthermore, binary logistic regression revealed that insight and retardation can predict recurrence. Lack of insight is associated with recurrence and impaired cognitive flexibility in patients with MDD.

Potential of Circulating miRNAs as Molecular Markers in Mood Disorders and Associated Suicidal Behavior.

Mood disorders are the most prevalent psychiatric disorders associated with significant disability, morbidity, and mortality. The risk of suicide is associated with severe or mixed depressive episodes in patients with mood disorders. However, the risk of suicide increases with the severity of depressive episodes and is often presented with higher incidences in bipolar disorder (BD) patients than in patients with major depression (MDD). Biomarker study in neuropsychiatric disorders is critical for developing better treatment plans by facilitating more accurate diagnosis. At the same time, biomarker discovery also provides more objectivity to develop state-of-the-art personalized medicine with increased accuracy through clinical interventions. Recently, colinear changes in miRNA expression between brain and systemic circulation have added great interest in examining their potential as molecular markers in mental disorders, including MDD, BD, and suicidality. A present understanding of circulating miRNAs in body fluids implicates their role in managing neuropsychiatric conditions. Most notably, their use as prognostic and diagnostic markers and their potential role in treatment response have significantly advanced our knowledge base. The present review discusses circulatory miRNAs and their underlying possibilities to be used as a screening tool for assessing major psychiatric conditions, including MDD, BD, and suicidal behavior.

Comparison of the efficacy of venlafaxine and bupropion in the treatment of depressive episode in patients with bipolar II disorder.

Depressive disorders are common among those with bipolar disorder II (BD II) and may necessitate the use of antidepressants. Because of the lack of quality evidence, there is controversy about the use of antidepressants in BD II. The aim was to compare the efficacy of venlafaxine and bupropion in the treatment of depressive episode in BD II. This randomized triple-blind clinical trial study was conducted on patient with depressive episode of BD II (based on diagnostic and statistical manual of disorders [DSM-V] criteria) referred to the specialized clinic of Golestan Hospital. A total of 40 patients were randomly divided into two groups of receiving venlafaxine (75 mg/day) or bupropion (100 mg/day) for 4 weeks. At the end of the intervention, the effectiveness of treatment was assessed using the Hamilton Depression Rating Scale (HDRS). The results of this study showed that the HDRS score before treatment (P = 0.43) and after treatment (P = 0.15) was not significantly different between the two groups. HDRS score in both groups significantly decreased after 4 weeks (P < 0.0001). Although the rate of decrease in depression score was more in venlafaxine than in bupropion, these differences were not significant (% 36.7 ± 21.8 vs. % 45.3 ± 17.9, P value = 0.17). Our study showed that short-term (4-weeks) treatments of venlafaxine and bupropion were equally effective and could be a safe and effective antidepressant monotherapy for BD II major depression. It is suggested that more studies be conducted with larger sample size and over longer periods of time in a multicenter manner.

Modafinil as an alternative in the treatment of excessive daytime sleepiness associated with affective disorders

Excessive daytime sleepiness or an increased need for sleep are an increasingly common reason of medical appointments. For years, the literature on sleep disorders has reported a complex two-way relationship between excessive sleepiness and mental disorders – especially mood disorders, which include winter depression in seasonal affective disorder. Assessment and effective treatment of excessive sleepiness in patients with seasonal affective disorder is an important component of the therapy. Hypersomnia is often a residual symptom of affective disorders, compromising the quality of life and daily functioning. Modafinil is an agent used in adults to treat excessive sleepiness associated with narcolepsy, with or without cataplexy. In addition to the registered indications, previous studies have shown efficacy and good tolerance of modafinil as augmentation treatment of depressive episodes in patients with residual symptoms in the form of fatigue and excessive daytime sleepiness, who received drugs from the group of serotonin reuptake inhibitors. The aim of this paper is to present the problem of excessive daytime sleepiness in the course of seasonal affective disorder and to propose modafinil therapy.

Effectiveness and Tolerability of Lurasidone for Bipolar Types I and II and Other Specified Bipolar Depression: A 12-Week Observational Study.

There are few guidelines on the management of depressive episodes in patients with bipolar type II (BDII) and related disorders (other specified bipolar and related disorders [OSBD]). Lurasidone is a potential option for treating depressive episodes in BDII/OSBD. This retrospective chart review study aimed to examine the effectiveness and tolerability of lurasidone for use in patients with bipolar depression. We reviewed 66 consecutive outpatients with bipolar depression who were prescribed lurasidone between June 2020 and January 2021 and examined 12-week outcomes. Fourteen patients were diagnosed with BDI, and 52 patients were diagnosed with BDII/OSBD (42 BDII and 10 OSBD). Depressive symptoms were evaluated by the Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR) at baseline and 2, 4, and 12 weeks. Tolerability was assessed throughout the study period by the incidence of adverse events, such as akathisia, nausea, and manic/hypomanic switch, as well as the lurasidone dropout rate due to adverse events. The total QIDS-SR score at 2 ( P < 0.001), 4 ( P < 0.001), and 12 weeks ( P < 0.001) was significantly lower than that measured at baseline. Remission rate during study period was 29.1%. Of the 66 participants, 47 (71.2%) continued taking lurasidone and 27 (40.9%) and 16 (24.2%) reported adverse events and akathisia, respectively. No significant difference in total QIDS-SR score, dropout rate due to adverse events, rate of adverse events, or rate of akathisia was found between the BDII/OSBD and BDI groups. Lurasidone is tolerated and could be effective for managing depressive episodes in patients with BDII/OSBD and BDI.

Treatment Patterns During Major Depressive Episodes Among Patients with Major Depressive Disorder: A Retrospective Database Analysis.

BackgroundMajor depressive disorder, a highly prevalent mental health condition, can be challenging to treat.ObjectiveWe aimed to characterize treatment patterns within and across multiple major depressive episodes in patients receiving treatment for major depressive disorder.MethodsAdults with newly diagnosed major depressive disorder and one or more major depressive episodes were identified using the IBM® MarketScan® Commercial database. Eligible patients had 12 months of continuous enrollment before and after diagnosis. Lines of therapy were periods of continuous treatment with one or more antidepressant claims. Antidepressant, atypical antipsychotic, or mood stabilizer regimens as monotherapy or adjunctive therapy were characterized by lines of therapy and major depressive episodes. Descriptive analyses were performed.ResultsA total of 455,082 patients were included in the analysis. The majority of treatment regimens were monotherapy, which decreased with subsequent lines of therapy, while adjunctive treatments increased with subsequent lines of therapy. There were 1860 unique adjunctive regimens identified. Of the 40,315 patients (9%) who received adjunctive therapy, 8024 (20%; 2% of all patients) received atypical antipsychotic-adjunctive regimens. Only 19% of patients treated with atypical antipsychotic-adjunctive therapy discontinued treatment versus 42% of monotherapy-treated patients. On average, patients who received an adjunctive atypical antipsychotic received it as their third line of therapy and approximately 400 days after the initial antidepressant treatment.ConclusionsIn this study, many patients continued monotherapy major depressive disorder regimens and experienced multiple treatment changes. Few patients were treated with adjunctive therapy. These results suggest underutilization of potentially effective treatments, which represents an opportunity to optimize the treatment of patients with major depressive disorder.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00316-4.

Characterization of Depressive Symptoms Trajectories After Breast Cancer Diagnosis in Women in France

Breast cancer (BC) diagnosis and treatment expose patients to a 5-fold higher risk of depression compared with the general population, with an estimated prevalence of 10% to 25%. A depressive episode in patients with BC has implications for the tolerance of and adherence to treatment, impairing quality of life and reducing life expectancy. To identify and characterize distinct longitudinal patterns of depressive symptoms in patients with BC from diagnosis to 3 years after treatment. The CANTO-DEePRESS (Deeper in the Understanding and Prevention of Depression in Breast Cancer Patients) cohort study included women in the French multicenter CANTO (CANcer TOxicities) cohort study (conducted between March 20, 2012 and December 11, 2018), who were 18 years or older with invasive stage I to III BC and no previous BC treatment. The study aimed to characterize toxicities over a 5-year period following stage I to III primary BC treatment. Assessments of depressive symptoms were performed on a subset of patients with available data at diagnosis and at least 2 other time points. All data were extracted from the CANTO database on October 1, 2020. The primary outcome was the level of depressive symptoms at each assessment time point measured with the Hospital Anxiety and Depression Scale and depression subscale at BC diagnosis and at 3 to 6, 12, and 36 months after the end of treatment. The group-based trajectory modeling was used to identify trajectory groups, and multinomial logistic regression models were used to characterize the following factors associated with trajectory group affiliation: demographic, socioeconomic, clinical, lifestyle, and quality-of-life data. A total of 4803 women (mean [SD] age, 56.2 [11.2] years; 2441 patients [50.8%] with stage I BC) were included in the study. Six trajectory groups that described the heterogeneity in the expression of depressive symptoms were identified: noncases with no expression of symptoms (n = 2634 [54.8%]), intermediate worsening (1076 [22.4%]), intermediate improvement (480 [10.0%]), remission (261 [5.4%]), delayed occurrence (200 [4.2%]), and stable depression (152 [3.2%]). HADS-D scores at diagnosis were consistently associated with the 5 depressive trajectory group affiliations, with an estimated higher probability per point increase of experiencing subthreshold or clinically significant depressive symptoms between diagnosis and the 3 years after the end of BC treatment. The higher probabilities ranged from 1.49 (95% CI, 1.43-1.54) for the intermediate worsening group to 10.53 (95% CI, 8.84-12.55) for the stable depression group. Trajectory groups with depressive symptoms differed from the noncases group without symptoms by demographic and clinical factors, such as having dependent children, lower household income, cancer stage, family history of BC, previous psychiatric hospitalizations, obesity, smoking status, higher levels of fatigue, and depression at diagnosis. In this cohort study, nearly a third of patients with BC experienced temporary or lasting significant depressive symptoms during and after treatment. Improving early identification of women at risk of developing long-term or delayed depression is therefore critical to increase quality of life and overall survival. Subjected to validation, this study is an important first step toward personalized care of patients with BC at risk of depression.

The network structure of depressive symptomatology in Peruvian adults with arterial hypertension.

Background: Globally, arterial hypertension (AH) has increased by 90% over the last four decades, and has increased by 1.6% in Peru over the previous four years. Scientific evidence indicates the prevalence of depressive symptoms in patients with AH and its importance in the comprehensive evaluation of the adult for adherence to clinical treatment. Previous studies carried out in the Peruvian population with AH mostly report the prevalence and associations, but do not indicate which depressive symptoms are more relevant in patients with AH. This study involved a network analysis of depressive symptomatology in Peruvian patients with AH using network estimation. Network analysis is used in this study for analysis, control, and monitoring purposes. Method: A representative cross-sectional study at the national level, using secondary data from 2019 Demographic and Family Health Survey (ENDES) was performed. The sample used included men and women of age over 17 years diagnosed with AH and was able to respond to Patient Health Questionnaire-9 (PHQ-9). Results: The symptoms of depressive mood (bridging force and centrality) and energy fatigue or loss (bridge centrality) play an essential role in the network structure, as does the feeling of uselessness in terms of closeness and intermediation. Conclusion: The study highlighted the symptoms related to depressive mood and energy fatigue or loss as bridging symptoms, which could trigger a depressive episode in patients diagnosed with AH. The results will contribute to developing personalized treatments aimed at patients with specific depressive symptoms who have also been diagnosed with AH. The study analysis presents statistical coefficients of effect size (≤ 0,1 = small; > 0,1 to < 0,5 = moderate; ≥ 0,5 = large) to determine network connections.

The use of atypical antipsychotics in the therapy of depressive episodes in patients with bipolar disorder

This literature review addresses the effi cacy and safety of atypical antipsychotics in patients with bipolar depression. Th e results of randomized studies and systematic meta-analyses of recent years were revised in detail. The effi cacy of the drug intake was reviewed for the following key research points: Clinical General Impression of Condition Severity Scale (CGI-S) and Montgomery-Asberg Depression Rating Scale (MADRS). A systematic literature search was carried out using Scopus, Web of Science, MedLine, elibrary, and other databases.

Lithium as a first‐step option for acute phase pharmacotherapy of bipolar depression

A recently published summary of the 2020 clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists provides recommendations on management of bipolar disorder (1). The acute phase pharmacotherapy of a depressive episode in patients with bipolar disorder, in the following referred to as treatment of bipolar depression, is especially challenging. The evidence for lithium as a treatment of bipolar depression is limited and conflicting (2), and therefore the positioning of this drug for the treatment of bipolar depression in upcoming guidelines is of particular interest.

Ganglion cell complex thickness changes in patients with different states of bipolar disorder.

Neuroimaging studies in patients with bipolar disorder have suggested that a neuropathological process may be effective in this disease. Neurodegenerative changes in the retina can be followed by optical coherence tomography, a non-invasive imaging method that allows in vivo visualization of the retinal layers. The aim of this study was to investigate the possible differences in optical coherence tomography parameters during euthymic, manic, and depressive episodes in patients diagnosed with bipolar disorder. A total of 150 patients with bipolar disorder were included in the study, divided into three groups (50 patients in a euthymic state, 50 patients in a manic state, and 50 patients in a depressive state) and compared with 50 healthy controls. Ganglion cell complex thickness was measured with automated macular segmentation software of spectral-domain optical coherence tomography. Ganglion cell complex thicknesses were thicker in all quadrants in patient groups than the control group but the differences were significant in perifoveal superior and perifoveal inferior quadrants (p < 0.001, p < 0.001). There were no differences in ganglion cell complex thickness among the patient groups (p > 0.05). The evaluation of ganglion cell complex thickness by spectral-domain optical coherence tomography may give a clue for monitoring neurodegenerative changes in patients with bipolar disorder.

The network structure of depressive symptomatology in Peruvian adults with arterial hypertension

Background: Globally, arterial hypertension (AH) has increased by 90% over the last four decades, and has increased by 1.6% in Peru over the previous four years. Scientific evidence indicates the prevalence of depressive symptoms in patients with AH and its importance in the comprehensive evaluation of the adult for adherence to clinical treatment. Previous studies carried out in the Peruvian population with AH mostly report the prevalence and associations, but do not indicate which depressive symptoms are more relevant in patients with AH. This study involved a network analysis of depressive symptomatology in Peruvian patients with AH using network estimation. Network analysis is used in this study for analysis, control, and monitoring purposes. Method: A representative cross-sectional study at the national level, using secondary data from 2019 Demographic and Family Health Survey (ENDES) was performed. The sample used included men and women of age over 17 years diagnosed with AH and was able to respond to Patient Health Questionnaire-9 (PHQ-9). Results: The symptoms of depressive mood (bridging force and centrality) and energy fatigue or loss (bridge centrality) play an essential role in the network structure, as does the feeling of uselessness in terms of closeness and intermediation. Conclusion: The study highlighted the symptoms related to depressive mood and energy fatigue or loss as bridging symptoms, which could trigger a depressive episode in patients diagnosed with AH. The results will contribute to developing personalized treatments aimed at patients with specific depressive symptoms who have also been diagnosed with AH. The study analysis presents statistical coefficients of effect size (≤ 0,1 = small; > 0,1 to < 0,5 = moderate; ≥ 0,5 = large) to determine network connections.

The network structure of depressive symptomatology in Peruvian adults with arterial hypertension

Background: Globally, arterial hypertension (AH) has increased by 90% over the last four decades, and has increased by 1.6% in Peru over the previous four years. Scientific evidence indicates the prevalence of depressive symptoms in patients with AH and its importance in the comprehensive evaluation of the adult for adherence to clinical treatment. Previous studies carried out in the Peruvian population with AH mostly report the prevalence and associations, but do not indicate which depressive symptoms are more relevant in patients with AH. This study involved a network analysis of depressive symptomatology in Peruvian patients with AH using network estimation. Network analysis is used in this study for analysis, control, and monitoring purposes. Method: A representative cross-sectional study at the national level, using secondary data from 2019 Demographic and Family Health Survey (ENDES) was performed. The sample used included men and women of age over 17 years diagnosed with AH and was able to respond to Patient Health Questionnaire-9 (PHQ-9). Results: The symptoms of depressive mood (bridging force and centrality) and energy fatigue or loss (bridge centrality) play an essential role in the network structure, as does the feeling of uselessness in terms of closeness and intermediation. Conclusion: The study highlighted the symptoms related to depressive mood and energy fatigue or loss as bridging symptoms, which could trigger a depressive episode in patients diagnosed with AH. The results will contribute to developing personalized treatments aimed at patients with specific depressive symptoms who have also been diagnosed with AH. The study analysis presents statistical coefficients of effect size (≤ 0,1 = small; > 0,1 to < 0,5 = moderate; ≥ 0,5 = large) to determine network connections.

Preventive effect of morning light exposure on relapse into depressive episode in bipolar disorder.

Light therapy has been suggested to have a curative effect on bipolar depression; however, preventive effects of light exposure on depressive episodes remain unclear. This study evaluated whether daytime light exposure in real-life situations was associated with a preventive effect on relapse into depressive episodes in patients with bipolar disorder. This prospective, naturalistic, observational study was conducted in Japan between August 2017 and June 2020. Outpatients with bipolar disorder were objectively evaluated for daytime light exposure over 7 consecutive days using an actigraph that could measure ambient light at baseline assessment and then assessed at 12-month follow-up for relapse into mood episodes. Of 202 participants, 198 (98%) completed follow-up at 12 months and 78 (38%) experienced relapse into depressive episodes during follow-up. In a Cox proportional hazards model adjusting for potential confounders, a longer time above 1000 lux at daytime was significantly associated with decrease in relapse into depressive episodes (per log min; hazard ratio, 0.66; 95% confidence interval, 0.50-0.91). In addition, a higher average illuminance and longer time above 1000 lux in the morning exhibited a significant decrease in relapse into depressive episodes (per log lux and per log min; hazard ratio, 0.65 and 0.61; 95% confidence interval, 0.49-0.86 and 0.47-0.78, respectively). The association between daytime light exposure and relapse into manic/hypomanic/mixed episodes was not significantly different. A significant association was observed between increased daytime light exposure, mainly in the morning, and decreased relapse into depressive episodes.

Lamotrigine in bipolar disorder: preventing depression to treat the disease

The aim of this paper is to critically ascertain the effectiveness of lamotrigine (LTG) as a key strategy for the treatment of bipolar I disorder. PubMed and Cochrane Library databases were searched using the following keywords: "lamotrigine" AND "bipolar disorder", "psychotic" or "mood disorder". Lamotrigine, has shown significant efficacy in preventing or delaying the onset of depressive episodes in bipolar disease. The standard final dose is 200 mg/day to be achieved with slow titration. The concomitant use of LTG and valproic acid requires a reduction of the standard final dosage of LTG to 100 mg/day in order to prevent the occurrence of adverse reactions, while an increase in the dosage of LTG (up to a maximum of 400 mg/day) is required in the case of concomitant use of enzyme inducers, such as carbamazepine. Lamotrigine is well tolerated and has a relatively low risk of side effects. Slow titration and accurate monitoring in the first weeks of treatment are necessary in order to reduce the risk of adverse events, such as severe skin rash, whose onset is however rare in the adult population (0.1%). It is possible to use LTG during pregnancy, breastfeeding or in subjects with liver or kidney disorders, following a preliminary assessment of the risk-benefit ratio. Lamotrigine is suitable for preventing or delaying the onset of depressive episodes in patients with bipolar I disorder, and has a high level of tolerability. Prevention of depression determines stabilization of bipolar disease and may contribute to a better overall outcome in patients with predominantly depressive episodes. In patients with a clinical history characterized by severe and repeated manic episodes, it is advisable to combine LTG with an antimanic agent (e.g. lithium or second generation antipsychotic) even in the maintenance phase. Lamotrigine is a valid therapeutic option in the long-term prevention and stabilization of the depressive phases in patients with bipolar I disorder.