HAMD Scores Research Articles

Effects of electroconvulsive therapy on inflammatory markers and depressive symptoms in adolescents with major depressive disorder

ObjectiveLimited research exists on the use of electroconvulsive therapy (ECT) for adolescents with major depressive disorder (MDD). This study investigates the effects of ECT on inflammatory markers in adolescents aged 13-18 suffering from severe MDD, evaluating its efficacy in modulating cellular inflammatory markers and ameliorating depressive symptoms.MethodsA cohort of 38 adolescents with severe MDD received standard antidepressant therapy along with 6-8 ECT sessions spanning two weeks. A control group of 29 age-matched, healthy individuals was also assessed for comparative purposes. The investigation measured variations in depressive symptomatology and inflammatory marker levels (IL-1β, IL-6, IL-10) pre- and post-intervention.ResultsPost-ECT, a substantial decrease in pro-inflammatory cytokines (IL-1β and IL-6) and an increase in the anti-inflammatory cytokine (IL-10) were noted. Participants who responded to the treatment showed a significant decline in HAMD-17 scores, which accentuates ECT’s therapeutic potential. Comparative analysis indicated a significant correlation between post-treatment inflammatory marker alterations and clinical improvement, implying that shifts in inflammatory state might serve as predictors of treatment response. Moreover, the mitigation of depressive symptoms exhibited a moderate correlation with post-treatment decrements in IL-1β and IL-6 levels, underscoring MDD’s intricacy and ECT’s comprehensive impact.ConclusionWhile initial inflammatory marker levels did not predict the response to ECT, the post-treatment measures appeared to be linked to clinical improvement. These findings suggest ECT’s potential effectiveness in treating severe MDD in adolescents and point to the possible predictive value of inflammatory markers in therapeutic outcomes. The study contributes to our understanding of the biopsychosocial framework of MDD and indicates that ECT may be a viable treatment option for this population.

Transcranial Doppler ultrasound in evaluating cerebral blood flow abnormalities in major depressive disorder.

Previous research has shown that blood flow abnormalities affect major depressive disorder (MDD) from multiple perspectives. Therefore, this study aims to investigate the relationship between middle cerebral artery (MCA) blood flow velocity parameters and clinical symptom scores (Hamilton Depression Rating Scale [HAMD] and Montgomery-Åsberg Depression Rating Scale [MADRS]) in patients with MDD. We compared the MCA blood flow velocity parameters, including peak systolic velocity (MCA-PSV), end-diastolic velocity (MCA-EDV), and mean velocity (MCA-MV), between 50 MDD patients and 50 control subjects. Additionally, we analyzed the correlation between these parameters and HAMD and MADRS scores. Hemodynamic parameters such as pulsatility index and resistance index were also compared between the 2 groups. MCA-PSV, MCA-EDV, and MCA-MV were significantly lower in MDD patients compared to the control group, while pulsatility index and resistance index were significantly higher. Correlation analysis revealed that MCA-PSV, MCA-EDV, and MCA-MV were significantly negatively correlated with HAMD and MADRS scores in MDD patients, indicating that cerebral blood flow velocity decreases as depressive symptoms worsen. Furthermore, regression analysis confirmed the negative relationship between blood flow velocity parameters and clinical symptom scores. The results of this study suggest that the reduction in cerebral blood flow velocity in MDD patients may be associated with the severity of depressive symptoms. This finding provides new insights into the pathophysiological mechanisms of MDD and offers a potential theoretical basis for developing depression treatment strategies based on cerebral blood flow velocity parameters.

Gene expression of kynurenine pathway enzymes in depression and following electroconvulsive therapy.

This study aimed to investigate changes in mRNA expression of the kynurenine pathway (KP) enzymes tryptophan 2, 3-dioxygenase (TDO), indoleamine 2, 3-dioxygenase 1 and 2 (IDO1, IDO2), kynurenine aminotransferase 1 and 2 (KAT1, KAT2), kynurenine monooxygenase (KMO) and kynureninase (KYNU) in medicated patients with depression (n = 74) compared to age- and sex-matched healthy controls (n = 55) and in patients with depression after electroconvulsive therapy (ECT). Associations with mood score (24-item Hamilton Depression Rating Scale, HAM-D24), plasma KP metabolites and selected glucocorticoid and inflammatory immune markers known to regulate KP enzyme expression were also explored. HAM-D24 was used to evaluate depression severity. Whole blood mRNA expression was assessed using quantitative real-time polymerase chain reaction. KAT1, KYNU and IDO2 were significantly reduced in patient samples compared to control samples, though results did not survive statistical adjustment for covariates or multiple comparisons. ECT did not alter KP enzyme mRNA expression. Changes in IDO1 and KMO and change in HAM-D24 score post-ECT were negatively correlated in subgroups of patients with unipolar depression (IDO1 only), psychotic depression and ECT responders and remitters. Further exploratory correlative analyses revealed altered association patterns between KP enzyme expression, KP metabolites, NR3C1 and IL-6 in depressed patients pre- and post-ECT. Further studies are warranted to determine if KP measures have sufficient sensitivity, specificity and predictive value to be integrated into stress and immune associated biomarker panels to aid patient stratification at diagnosis and in predicting treatment response to antidepressant therapy.

Treatment of post-stroke fatigue with point-toward-point insertion of elongated needle and Tongdu Tiaoshen therapy of acupuncture: a randomized controlled trial

To observe the effect of point-toward-point insertion of elongated needle on post-stroke fatigue and explore its underlying mechanism. Sixty-four patients with post-stroke fatigue were randomly divided into an observation group (32 cases, 2 cases dropped out) and a control group (32 cases, 2 cases dropped out). In addition to the conventional treatment of western medicine and rehabilitation exercises, Tongdu Tiaoshen (regulating the governor vessel and the spirit) therapy of acupuncture was used in the control group, and acupuncture was applied to Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), Fengfu (GV 16) and bilateral Fengchi (GB 20) and the needles were retained for 30 min in one treatment. In the observation group, besides the interventions as the control group, point-toward-point insertion of elongated needle was adopted. The needle was inserted from Zhiyang (GV 9) toward Dazhui (GV 14), from Shendao (GV 11) toward Yaoyangguan (GV 3) and from Yaoqi (EX-B 9) toward Yaoyangguan (GV 3); and the needles were retained for 30 min in one treatment. In the two groups, the acupuncture was delivered once daily, 6 times a week, consecutively for 4 weeks. The scores of the fatigue severity scale (FSS), Pittsburgh sleep quality index (PSQI), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), and Fugl-Meyer assessment (FMA) were observed before and after treatment completion in the two groups. Using ELISA, the levels of serum interleukin (IL)-1β, IL-6, IL-10, high-sensitivity C-reactive protein (hs-CRP), and homocysteine (Hcy) were detected before and after treatment completion; and clinical effect was evaluated. The scores of FSS, PSQI, HAMA and HAMD, as well as the levels of serum IL-1β, IL-6, hs-CRP and Hcy were reduced (P<0.05), and the scores of FMA and the levels of serum IL-10 were increased (P<0.05) after treatment in comparison with those before treatment in the two groups. Compared with the control group, in the observation group, the scores of FSS, PSQI, HAMA and HAMD, and the levels of serum IL-1β, IL-6, hs-CRP and Hcy were reduced (P<0.05, P<0.01), and the score of FMA and the level of serum IL-10 were increased (P<0.05). The total clinical effective rate was 83.3% (25/30) in the observation group, which was higher than 73.3% (22/30) of the control group (P<0.05). The point-toward-point insertion of elongated needle alleviates fatigue, anxiety and depression, and ameliorates sleep and motor function in the patients with post-stroke fatigue. It may be related to the attenuation of inflammatory responses.

Targeting Method for rTMS for Treating Depression in Japanese Patients: A Comparison of the Standard, F3, and Neuronavigation Approaches

Introduction: The left dorsolateral prefrontal cortex (lDLPFC) is a commonly targeted brain region for repetitive transcranial magnetic stimulation (rTMS) for depression. The lDLPFC has been identified using the “5-cm rule.” However, identification of the lDLPFC may deviate from the ideal stimulation site localized by neuronavigation. Therefore, we aimed to compare this method with other methods and examine the relationship between deviation from the ideal stimulation site and treatment effects. While most existing studies have focused on participants of European descent, this study focused on Japanese participants. Methods: The study participants were 16 patients who underwent rTMS and had the stimulus location identified using the 5-cm method. The lDLPFC was identified by the F3 electrode position and neuronavigation in addition to the 5-cm rule, and these locations were compared. We then performed a correlation analysis of the distance between the sites identified by the 5-cm method and by neuronavigation, as well as changes in scores on the 17-item Hamilton Depression Scale (HAMD-17). Results: The lDLPFC identified by the F3 site and neuronavigation was approximately 3 cm more anterolateral than that identified by the 5-cm method. A significant correlation was found between the distance between the sites identified by the 5-cm method and neuronavigation and the rate of change in HAMD-17 scores. Conclusion: The ideal stimulation site may be approximately 3 cm anterior to the site identified by the 5-cm method, and stimulation of the F3 site may be a valid alternative to the 5-cm method.

Application effect of task-oriented multi-dimensional nursing intervention in patients with coronary atherosclerotic heart disease and concurrent hypertension

Background: The purpose of this study was to explore the application effect of task-oriented multi-dimensional nursing interventionin patients with coronary atherosclerotic heart disease (CAD) and concurrent hypertension. Methodology: The clinical data of 196 patients with CAD and concurrent hypertension in our hospital between January 2019 and January 2022 were retrospectively analysed. The patients receiving task-oriented multi-dimensional nursing were set as study group (n=98), while those given routine nursing as control group (n=98). The two groups were compared in the Hamilton Anxiety Scale (HAMA) scores, left ventricular end-diastolic diameter (LVEDD), 36-Item Short Form Health Survey (SF-36) scores, left ventricular ejection fraction (LVEF), Hamilton Depression Scale (HAMD) scores, systolic blood pressure (SBP), treatment compliance and incidence rates of adverse events. Results: After intervention, study group showed lower HAMA and HAMD scores, SBP and LVEDD, but higher SF-36 scores and LVEF than control group (P&lt;0.05). The treatment compliance rate was higher in control group than that in study group (92.86% vs. 80.61%), while an opposite result was detected in the total incidence rate 5.10% vs. 13.27%, P&lt;0.05). Conclusion: Multidimensional nursing benefits CAD patients with hypertension, improving emotions, compliance, and quality of life, reducing adverse events, and promoting recovery. Recommended for clinical use. Keywords: Coronary atherosclerotic heart disease; task-oriented theory; multi-dimensional nursing care; clinical nursing.

Electroconvulsive Therapy Regulates the Interhemispheric Functional Connectivity of the Dorsomedial Prefrontal Cortex in Depressive Patients: Evidence from 2 Independent Samples.

The dorsomedial prefrontal cortex (dmPFC) is considered a crucial node in emotional and cognitive processes. Voxel-mirrored homotopic connectivity (VMHC) is a validated methodology for investigating interhemispheric coordination. This study aims to elucidate the effects of electroconvulsive therapy (ECT) on the interhemispheric connectivity of the dmPFC in patients with depression, using VMHC as a measure of bilateral neural coordination. Thirty-three patients with depression, screened at the University of Science and Technology of China (USTC), and thirty-five patients with depression, screened at Anhui Medical University (AHMU), were selected as the subjects of this study. VMHC was employed to investigate the effects of ECT on bilateral hemispheric functional connectivity. The Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms, and the relationships between changes in HAMD scores and VMHC values were examined. Following ECT, the depressive symptoms of all participants decreased (p < 0.001). The VMHC values in the dmPFC were significantly increased in both groups after ECT (p < 0.01). No significant correlation was found between the increasing VMHC values in the dmPFC and the changes in HAMD scores in depressed patients (p > 0.05). These results show that ECT regulates interhemispheric functional connectivity in depressed patients, and significantly increases the VMHC values in the dmPFC. Our findings may provide a useful method for optimizing the treatment of depression.

Correlations of gray matter volume with peripheral cytokines in Parkinson's disease

IntroductionPeripheral cytokine levels may affect specific brain volumes. Few studies have examined this possible relationship. ObjectiveIn a case–control study, we used magnetic resonance imaging (MRI) voxel-based morphological analysis techniques to examine the relationship between gray matter volume changes and cognitive, motor and emotional dysfunction as well as between gray matter volume changes and peripheral blood cytokine levels. MethodA total of 134 subjects, comprising 66 PD patients and 68 healthy controls, were recruited. Peripheral venous blood was collected to measure the concentrations of 12 cytokines, including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, IFN-α, IFN-γ, and TNF-α. All the subjects also underwent MRI, where 3D-T1-weighted MR images were used for the analysis. In addition, the Montreal Cognitive Assessment (MoCA), Mini-Mental Status Examination (MMSE), Unified Parkinson's disease Rating Scale (UPDRS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) scores were assessed in PD patients. Statistical parameter mapping 12 software was used for the statistical analysis of the images. ResultCompared with control patients, PD patients presented decreased gray matter volume (GMV) in the bilateral frontal lobe, temporal lobe, parietal lobe, occipital lobe, insula, and right cerebellar lobule VIII. Regional GMV in the temporal lobe, parietal lobe, and cerebellum was correlated with MoCA, MMSE, UPDRS, HAMA, and HAMD scores in PDs. In addition, the regional GMV in PDs was correlated with the concentrations of cytokines, including IL-4, IL-6, IFN-γ, and TNF-α. The IL-6 concentration was negatively correlated with the UPDRS-IV score. ConclusionPD patients exhibit gray matter atrophy in a wide range of brain regions, which are symmetrically distributed and mainly concentrated in the frontal and temporal lobes, and these changes may be linked to motor disorders and neuropsychiatric manifestations. Cytokine concentrations in peripheral blood are correlated with regional gray matter volume in PDs, and the IL-6 level affects gray matter volume in the left precentral gyrus and the manifestation of motor complications.

Association between polygenic risk scores combined with clinical characteristics and antidepressant efficacy

BackgroundWhile millions of people suffer from major depressive disorder (MDD), research has shown that individual differences in antidepressant efficacy exist, potentially attributable to various factors. Polygenic risk scores (PRSs) carry clinical potential, but associations with treatment response are seldom reported. Here, we examined whether PRSs for MDD and schizophrenia (SCZ) are associated with antidepressant effectiveness and the influence of other factors. MethodsA total of 999 patients were included, and the PRSs for the MDD and SCZ were calculated. The main outcome was a change in the 17-item Hamilton Depression Rating Scale (HAMD17) scores from before to after 2-week treatment. The Mann-Whitney test, Spearman correlation analysis, multiple stepwise linear regression analysis, and interaction analysis were used for statistical analysis. ResultsIn the 912 subjects passing quality control, a difference in the HAM-D17 score reduction rate between the MDD phenotype PRS (MDD-PRS) high-risk and the low-risk groups was discovered (P = 0.009), and a correlation was found between the MDD-PRS and the HAM-D17 score reduction rate (r = −0.075, P = 0.024). Moreover, antidepressant efficacy was related to MDD-PRS (β = −4.086, P = 0.039), the Snaith-Hamilton Pleasure Scale-total score (β = −0.009, P = 0.005), and non-first episode (β = −0.039, P < 0.001). However, the result of the interaction analysis was nonsignificant. LimitationsThe main limitation was that only 1309 targeted genes were selected based on pathways known to be involved in MDD and/or antidepressant effects. ConclusionThese findings suggest a difference in antidepressant efficacy between patients in different MDD-PRS groups. Moreover, the MDD-PRS combined with clinical characteristics partially explained inter-individual differences in antidepressant efficacy.

Cortical activation during the verbal fluency task for obstructive sleep apnea patients with depressive symptoms: A multi-channel fNIRS study.

The aim of our study was to elucidate differences in brain activity patterns among obstructive sleep apnea (OSA) patients, OSA patients with depressive symptoms, and healthy controls (HCs). We also investigated the relationship between brain function and depression in OSA patients. A total of 95 subjects were included in the study, including 34 OSA patients without depressive symptoms, 31 OSA patients with depressive symptoms, and 30 HCs. The 53-channel functional near-infrared spectroscopy (fNIRS) was used to monitor the concentration of oxy-hemoglobin (Oxy-Hb) in the brain, whereas the participants performed the verbal fluency task, and the degree of depression was scored using the 17-item Hamilton Rating Scale for Depression (HAMD-17). Hierarchical regression models were conducted to analyze the association of fNIRS features with depressive symptom. The Oxy-Hb changes of the three groups were significantly different in Channels 25 (H=9.878, p=.007) and 43 (H=6.957, p=.031). Inter-group comparisons showed that the Oxy-Hb change of Channel 25 (located in the dorsolateral prefrontal cortex [DLPFC]) in OSA group was less than that in HC group (p=.006), and the Oxy-Hb change of Channel 43 (located in the right frontal polar region) in OSA group with depression was less than that in OSA group (p=.025). Spearman's test showed that there was a significant negative correlation between HAMD-17 scores and mean Oxy-Hb changes in Channel 43 (r=-.319, p<.05) in the OSA patients. Using hierarchical regression, Oxy-Hb changes in Channel 43 accounted for a significant proportion of the variation in outcome variables, even when accounting for other polysomnography features. Changes in the hemodynamic response of DLPFC may be a potential mechanism of executive dysfunction in OSA patients. And the right frontal polar region may be significant in assessing depressive symptoms in patients with OSA.

Augmentation with prazosin for patients with depression and a history of trauma: A randomised, double-blind, placebo-controlled study.

Depression with a history of trauma often responds poorly to conventional antidepressants and has a poor prognosis. Prazosin, an α1-adrenoceptor blocker, has shown promise in treating post-traumatic stress disorder symptoms, particularly nightmares. Its potential in treating depression with trauma history warrants investigation. This randomised, double-blind, placebo-controlled study aimed to investigate the efficacy and tolerability of low-dose prazosin (0.5-1 mg/day) as an augmentation strategy in patients with depression and a history of trauma. We sought to determine if prazosin could provide rapid symptom improvement and enhance overall treatment response compared to placebo in this difficult-to-treat patient population. This randomised, double-blind, placebo-controlled clinical study included 59 patients with first-episode or recurrent unipolar or bipolar depression. After basic antidepressant treatment, they were randomly assigned to a prazosin (0.5-1 mg/day) or placebo group for a 6-week double-blind controlled study. The Montgomery-Åsberg Depression Rating Scale, 17-item Hamilton Depression Scale (HAMD-17), and Hamilton Anxiety Scale (HAMA) were used to evaluate efficacy. There were no significant differences in the results of the demographic and clinical symptom assessment between the two groups (p > 0.05). The difference between the HAMD-17 and HAMA scores was statistically significant after 3 days of treatment (p < 0.05). The difference in response rate between the two groups was statistically significant after week 4 of treatment (end of week 4, 56.7% vs. 24.1%, p = 0.011; end of week 6, 80.0% vs. 48.3%, p = 0.011). The incidence of adverse reactions in the prazosin and placebo groups was 20.0% and 24.1%, respectively, with no statistically significant differences (p > 0.05); however, the prazosin group had a lower incidence of sleeplessness or nightmares (3.3% vs. 20.7%, p = 0.039) but a higher incidence of orthostatic hypotension (16.7% vs. 0%, p = 0.007). The severity of orthostatic hypotension was mild to moderate. Low-dose prazosin can effectively improve the emotional symptoms of patients with depression and a history of trauma, and the common adverse reaction is mild-to-moderate orthostatic hypotension. ChiCTR2200063642.

Effects of acupuncture combined with five-element music for people with mild/moderate post-stroke depression: A randomized controlled trial

ObjectivesTo evaluate the efficacy and safety of acupuncture combined with five-element music (FEM) as an therapeutic strategy for the physical and mental state of Post-stroke depression patients. Design and settingMulticenter, randomized clinical trial conducted at 3 hospitals in China and enrolling 237 patients with PSD between June 2019 and April 2021. Participants mild/moderate PSD (17-item GRID Hamilton Depression Scale (HAMD) score 7–24) were randomly assigned (1:1) to acupuncture combined with FEM (AFEM) group or cognitive behavioral therapy (CBT) group. Main outcome measuresThe primary outcome was change and differences between the groups in HAMD-17 from baseline to week 12. Secondary outcomes included Fugl-Meyer Assessment Scale score and Stroke-Specific Quality of Life Scale (SS-QOL) score. ResultsThe 237 patients in this intention-to-treat analysis were randomized into either the AFEM group (n=119) or the cognitive behavioral therapy (CBT) group (n=118). Of these 237 participants, 225 (94.9 %) completed all outcome measurements at week 12. The AFEM and CBT groups both showed significant improvement in HAMD-17 from baseline to week 12. Patients in the AFEM group had significantly lower HAMD-17 scores of −3.56 at week 8 (95 % CI,-4.59 to −2.53; p <.001) and −3.50 at week 12 (95 % CI,-4.53 to −2.46; p<.001) than patients in the CBT group. The SS-QOL score improved significantly at week 12. The Fugl-Meyer score was significantly lower in the AFEM group than in the CBT group at week 4, but this difference was not statistically significant upon follow-up at weeks 8 and 12. The incidence of treatment-related adverse events was 2.1 % in the AFEM group, with no serious adverse events reported. ConclusionsThe results suggest that acupuncture and five-element music significantly improve the depressive symptoms in this cohort of Chinese PSD patients, and the toxicities were similar with CBP group. RegistrationThis study registered with the ClinicalTrials.gov Identifier: ChiCTR1900023741.

Effectiveness and safety of Arecae Semen compounds for patients with depression: a systematic review and meta-analysis

BackgroundArecae Semen is a traditional herbal medicine widely used in the medical service and food industry, but in recent years, the carcinogenesis of edible Arecae Semen chewing has aroused comprehensive attention, therefore it is necessary to evaluate its medicinal properties. Increasing evidence has shown that Arecae Semen Compounds (ASC) possess antidepressant ability. This study aimed to evaluate the effectiveness and safety of ASC in the treatment of depression.MethodsWe retrieved articles in eight databases from their inception to May 2024. Randomized controlled trials (RCTs) comparing the effects of ASC alone or combined with routine treatment in patients with depression were identified. The Cochrane risk of bias (ROB) tool (ROB 2) was used for assessing the ROB in the included trials. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of the evidence for the review outcomes. The outcomes included Hamilton depression rating scale (HAMD) scores, depression-related symptoms, serum dopamine levels, and adverse events. Stata 14.0 was used for data analysis calculating standardized mean difference (SMD) for continuous outcomes and relative risk (RR) for binary outcomes, both with 95% confidence intervals (CI).ResultsNine RCTs involving 787 patients were included in this review. ASC lowered HAMD scores (SMD − 3.43, 95% CI − 5.24 to − 1.61; I2 = 95.2%, P < 0.001), alleviated depression-related symptoms, increased serum dopamine levels, and reduced the incidence of adverse events slightly (RR 0.18, 95% CI 0.04 to 0.77; I2 = 0, P = 0.775) compared with the control group. Publication bias might account for the asymmetrical presentation of funnel plots. Meta-regression analysis revealed that regarding HAMD scores, there was no significant relationship with duration, sample size, or treatment strategy. The evidence of the outcomes was of very low certainty.ConclusionsASC may achieve better therapeutic effects, alleviate depression-related symptoms with a lower incidence of adverse events, and provide a potentially effective and safe complementary therapy for patients with depression. However, the evidence is very uncertain so further researches are required to validate our results and explore clinical implications of Arecae Semen in depth.Systematic review registrationPROSPERO CRD42022361150.

Predictors of response to accelerated rTMS in the treatment of treatment-resistant depression.

Accelerated repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for treatment-resistant depression (TRD). We aimed to investigate the existence of clinical predictive factors in response to accelerated rTMS in the treatment of TRD. In total, 119 TRD patients who received accelerated rTMS were included in this study. The stimulation protocol was 15Hz stimulation over the the left dorsolateral prefrontal cortex. The protocol consisted of 25 sessions, each session lasting 30min for a total of 3000 pulses. Five sessions were applied per day for 5 consecutive days. At baseline (T0), day 5 (immediately after treatment) (T1), 4 weeks after treatment (T2), depression severity was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17), cognitive function was evaluated using Wisconsin Card Sorting Test (WCST), the intensity of suicidal ideation was evaluated using the Columbia-Suicide Severity Rating Scale (C-SSRS). Systemic immune-inflammation index (SII) was calculated at T0 and T2. The HAMD-17 scores, WCST performance, the C-SSRS scores at T1 and T2 were improved from T0 (P < 0.01). The SII at T2 was lower than at T0 (P < 0.01). The response rates at T1 and T2 were 57.98% (69/119) and 48.74% (58/119), respectively. The results of binary logistic analysis showed that shorter course of depression, two failed antidepressant trials, no history of ECT treatment, and lower levels of SII were predictive factors for accelerated rTMS treatment response at T1 and T2 (P < 0.05), while not having a history of hospitalization was a predictive factor for response at T2 (P < 0.05) but not at T1 (P > 0.05). Based on ROC curve analysis, the optimal cut-off values of SII for discriminating responders from non-responders at T1 and T2 were < 478.56 and < 485.03, respectively. The AUC of SII at T0 predicting response for T1 and T2 were 0.729 and 0.797. We found several clinical predictors of better responses to the accelerated rTMS. Identifying clinical predictors of response is relevant to personalize and adapt rTMS protocols in TRD patients.

Enhanced classification and severity prediction of major depressive disorder using acoustic features and machine learning.

Previous studies have classified major depression and healthy control groups based on vocal acoustic features, but the classification accuracy needs to be improved. Therefore, this study utilized deep learning methods to construct classification and prediction models for major depression and healthy control groups. 120 participants aged 16-25 participated in this study, included 64 MDD group and 56 HC group. We used the Covarep open-source algorithm to extract a total of 1200 high-level statistical functions for each sample. In addition, we used Python for correlation analysis, and neural network to establish the model to distinguish whether participants experienced depression, predict the total depression score, and evaluate the effectiveness of the classification and prediction model. The classification modelling of the major depression and the healthy control groups by relevant and significant vocal acoustic features was 0.90, and the Receiver Operating Characteristic (ROC) curves analysis results showed that the classification accuracy was 84.16%, the sensitivity was 95.38%, and the specificity was 70.9%. The depression prediction model of speech characteristics showed that the predicted score was closely related to the total score of 17 items of the Hamilton Depression Scale(HAMD-17) (r=0.687, P<0.01); and the Mean Absolute Error(MAE) between the model's predicted score and total HAMD-17 score was 4.51. This study's results may have been influenced by anxiety comorbidities. The vocal acoustic features can not only effectively classify the major depression and the healthy control groups, but also accurately predict the severity of depressive symptoms.

Oxidative Stress in Depression: A Case-control Study of Serum MDA Levels and Lipid Levels in Patients With Depression in a Tertiary Care Hospital in South India

Introduction: Numerous theories have been proposed to substantiate the etiopathogenesis of depression. Recently, the hypothesis involving the oxidative stress (OS) pathway has been explored. Hence, potential markers are also being investigated for their role in depression. We aimed to assess the serum malondialdehyde (MDA) and serum lipid levels in individuals with depression and controls and explore associated factors. Methodology: A semi-structured questionnaire, complete with a mandatory consent form and a reliable, validated scale, namely the Hamilton Depression scale (HAM-D), was used. The method of sampling was purposive, with 100 depression cases in the psychiatry outpatient being included and 50 age-matched, gender-matched controls. Blood was collected from both groups to evaluate serum MDA and serum Lipid levels. Appropriate statistics using SPSS 20 were administered. Results: Our study had a female preponderance in cases, with 38% having major depressive disorder (MDD), 50% of whom showed suicidal ideas, and 10% had a prior history of deliberate self-harm. Mean HAM-D scores were higher in cases than controls, 18.57 ± 6.02, and mean MDA levels were higher in cases, 2.5 ± 1.02 mmol/L. HDL levels were lower in depression cases compared to controls, 38.34 ± 7.442. An inverse correlation was seen between mean serum MDA levels and HDL levels in depression cases. A significant relationship was observed between the parameters of depression and serum MDA levels. Conclusion: Significantly elevated mean serum MDA levels were observed in depression cases, along with significantly lowered mean HDL values compared to controls. We found a positive correlation between serum MDA levels and the severity, recurrence, and suicidality of depression. An inverse relation was observed between serum MDA values and mean HDL levels in depression. This emphasizes the need for clinical vigilance in employing these biomarkers not merely for assessment but also for HDL as a preventive measure in depression.

Research on the soothing Liver - Qi stagnation method in the treatment of postoperative papillary thyroid carcinoma patients' concomitant depression: A randomized controlled clinical trial.

Postoperative papillary thyroid carcinoma (P-PTC) patients often grapple with depression fueled by the looming threat of recurrence. While the Liver-Qi stagnation method is frequently employed for depression management, a notable scarcity of clinical trials exists regarding its application in patients with P-PTC and concurrent depression. This study presents a randomized controlled clinical trial, aiming to establish the efficacy of the Liver-Qi stagnation method in alleviating depression in patients with P-PTC. In this randomized controlled clinical trial, P-PTC patients diagnosed with concomitant depression were systematically enrolled. Subjects were randomly assigned to either the control or test group, both receiving standard treatment comprising Levothyroxine sodium tablets and decoction of benefiting Qi and nourishing Yin. Additionally, the test group received supplementation with bupleuri radix-paeoniae alba radix (CH-BS) alongside the baseline therapy. The intervention spanned 12 weeks. Pre- and post-treatment evaluations were conducted using the Hamilton Depression Scale (HAMD), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Traditional Chinese Medicine (TCM) syndrome score scale. Concurrently, blood inflammatory factors and serum 5-hydroxytryptamine (5-HT) levels were measured to comprehensively assess treatment outcomes. During the 12-week intervention, the test group demonstrated a significant reduction in HAMD scores compared to the control group (P < .05). Moreover, post-treatment serum 5-HT levels were significantly elevated in the test group compared to the control group (P < .05). Findings gleaned from the EORTC QLQ - C30 revealed a noteworthy improvement in social function and overall quality of life scores within both groups post-treatment in comparison to baseline (P < .05). Concurrently, post-treatment scores for fatigue and insomnia symptoms witnessed a significant decrease compared to baseline (P < .05). Notably, the test group exhibited superior scores in the emotional domain in contrast to the control group (P < .05). Both groups exhibited a substantial decrease in TCM syndrome scores from baseline (P < .05). Noteworthy increases were found in IFN-γ < 2.44 rate (62.86%) and IL-6 < 2.44 rate (74.29%) in the test group compared to pretreatment levels (P < .05). The soothing Liver-Qi stagnation method induces a rise in serum 5-HT levels, reducing depression-related inflammatory factors, culminating in the alleviation of depression for P-PTC.

Impact of high-frequency rTMS combined with pharmacotherapy on the left dorsolateral prefrontal cortex in treating major depressive disorder: A real-world study

BackgroundRepetitive transcranial magnetic stimulation (rTMS) combined with pharmacotherapy is a promising treatment method for depression. However, its treatment mechanism needs further research. MethodsThis study recruited 38 healthy individuals (HC) and 52 patients with severe depression (MDD) and divided patients into two treatment groups: the rTMS combined antidepressant (rTMS+ADP) group and the single antidepressant (ADP) group. We used functional magnetic resonance imaging to calculate the fractional amplitude of low-frequency fluctuations (fALFF) in the left dorsolateral prefrontal cortex (DLPFC) to investigate the functional change after treatment. ResultThe fALFF in the left DLPFC was significantly lower in the MDD group than that in the HC group (p < 0.05). In addition, fALFF values of the left DLPFC negatively correlated with HAMD-24 scores (r = −0.294, p = 0.005). After treatment, both MDD groups showed a significant decrease in HAMD-24 scores, with a response rate of 88.89 % and a remission rate of 62.96 % in the rTMS+ADP group, compared to 64 % response and 56 % remission rates in the ADP group. The fALFF values in patients' left DLPFC significantly reduced in the rTMS+ADP group (p < 0.05), but not in the ADP group. LimitationsOur study only focused on the treatment effect in the left DLPFC, without exploring the other brain regions or networks. ConclusionsThis study emphasizes the significance of the left DLPFC in MDD treatment. However, combined left DLPFC rTMS with ADP causes deviation from the normal resting brain function of the left DLPFC, indicating that future research should explore targeted treatment methods to normalize the left DLPFC.

Electroconvulsive therapy combined with esketamine improved depression through PI3K/AKT/GLT-1 pathway

Neuron excitotoxic damage induced by extracellular glutamate accumulation pathologically is one of the main mechanisms of depression. Glutamate transporter-1 (GLT-1) expressed in astrocyte is responsible for glutamate clearance to maintain glutamate balance. Electroconvulsive therapy (ECT) is prevalently recommended for severe depression due to its significant anti-depressant effect. Esketamine could offer advantages of rapid anti-depressant effect and neuron protection. The aim of this study is to investigate the anti-depressant efficacy of esketamine plus ECT, and further to explore the mechanism.Firstly, total 12 patients were randomized into anesthesia with propofol (P) or propofol+esketamine (PK) before ECT. 24-Hamilton Depression Scale (HAMD) was used to evaluate the severity of depression after each ECT. Then, depressive rat model was built using chronic unpredictable mild stress method, and subsequently received infusion of esketamine (5 mg/kg) or saline before ECT treatment (0.5 mA; 100 V) for consecutive 10 days. Tests including sucrose preference test, open field test and forced swimming test were used to evaluate depression-like behaviors. In next experiments, rats were injected with RIL, DHK or LY294002 intracerebroventricularly for continuous 10 days before individual treatment.After the fifth and sixth ECT, PK group displayed lower HAMD score compared to P group. In rat model, we found that esketamine plus ECT could significantly improve depression-like behaviors and decrease glutamate level. Esketamine and ECT could both activate PI3K/Akt/GLT-1 pathway. The GLT-1 agonist RIL made equivalent effect as esketamine plus ECT. Furthermore, after using PI3K/Akt inhibitor LY294002 and GLT-1 inhibitor DHK, esketamine plus ECT could neither improve depression-like symptoms, nor upregulate GLT-1 level. Our present study suggested that esketamine plus ECT could dramatically improve depression symptom. The activation of PI3K/Akt/GLT-1 pathway may be the potential mechanism.

Observations on the efficacy of edaravone dexborneol in preventing post-stroke depression and its inflammatory mechanism: a prospective, randomized, control trial.

This study aimed to observe the effect of edaravone dexborneol (EDB) on the incidence of early post-stroke depression (PSD) and explore its inflammatory mechanisms. A prospective, randomized controlled study was conducted from January 2022 to June 2023, involving patients with acute ischemic stroke (AIS) at the Neurology Department of the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine. The control group received routine treatment, while the experimental group received routine combined EDB treatment. The main outcome measures included PSD incidence, Patient Health Questionnaire (PHQ-9) and Hamilton Depression Scale (HAMD) scores on days 14 and 30, and inflammatory factor levels on day 14. A total of 93 patients were included in the study, 51 in the experimental group and 42 in the control group. On day 14, the PSD incidence was 13.7% in the experimental group, lower than 31.0% in the control group (95%CI 0.127-0.996; p = 0.044). Compared to the control group, the experimental group showed significantly lower concentrations of pro-inflammatory cytokines IL-1β (95%CI 3.353-5.184), IL-6 (95%CI 2.694-3.426), TNF-α (95%CI 4.985-12.196), IFN-γ (95%CI 0.163-0.451), MCP-1 (95%CI 0.335-0.787), IL-17A (95%CI 0.543-1.024), and IL-23p19 (95%CI 1.677-1.959) (all p < 0.001), and higher levels of anti-inflammatory cytokines IL-4 (95%CI -1.087 to -0.941), IL-10 (95%CI -6.125 to -1.662), and IL-13 (95%CI -6.078 to -2.953) (all p ≤ 0.001). On day 30, the PSD incidence in the experimental group was 15.7%, lower than 40.5% in the control group (95%CI 0.103-0.725; p = 0.007). Compared with the control group, the experimental group had lower PHQ-9 scores on day 14 (95%CI 0.034-1.577; p = 0.041) and day 30 (95%CI 0.018-1.573; p = 0.045), and also had lower HAMD scores on day 14 (95% CI 0.281-2.856; p = 0.018) and day 30 (95% CI 0.647-3.482; p = 0.005). EDB could reduce the incidence of early PSD, reduce pro-inflammatory cytokine levels, and elevate anti-inflammatory cytokine levels, which was possibly related to the anti-inflammatory mechanism of EDB. http://www.chictr.org.cn/, identifier [ChiCTR2300067750].