Improvement In Depression Scores Research Articles

Does Improving Depression Symptoms in Young Adults With Inflammatory Bowel Disease Alter Their Microbiome?

Patients with inflammatory bowel diseases (IBDs) are more likely to have depression and anxiety symptoms compared with healthy individuals and those with other chronic illnesses. Previous studies have shown a link between the microbiome composition and depression symptoms; however, many antidepressant medications have antibacterial activity confounding cross-sectional studies of these populations. Therefore, we aimed to determine whether we could detect longitudinal changes in the microbiome of a subset of patients who participated in a previously published mindfulness-based cognitive therapy (MBCT) study to improve depression symptoms in adolescents and young adults with IBD. Stool samples were collected at baseline and 8 weeks (n = 24 participants, 37 total samples, 13 paired samples). During this time, some participants achieved a 50% reduction in their depression symptoms either through MBCT or treatment as usual with their mental health team (responders). The microbiome composition and function of responders were compared with participants who did not improve their depression scores (nonresponders). Depression scores were determined using the depression, anxiety, and stress score (DASS-21), and metagenomic sequencing of stool samples was performed. No difference in alpha diversity was found between responders and nonresponders. Beta diversity measures were similarly unchanged. Clinical features including fecal calprotectin, C-reactive protein, and serum IL-6 levels were unchanged. In this small longitudinal study, we were not able to detect longitudinal changes in the microbiome associated with improvement in depression scores. Follow-up studies that are sufficiently powered to detect changes in the microbiome are required to confirm our results.

Comparative analysis of treatment options for chronic heart failure and depression: a systematic review and Bayesian network meta-analysis.

Different interventions have been evaluated for the treatment of depression in heart failure (HF) patients. However, clear and established recommendations are lacking. PubMed, Scopus, and Web of Science databases were systematically searched for randomized controlled trials (RCT) evaluating the effect of various treatment options on depression scores in heart failure patients. The primary outcome was a change in depression scores presented as standardized mean difference (SMD). A Bayesian network for meta-analysis was constructed. Twenty-five RCTs were included, randomizing 6014 patients with confirmed heart failure and depression between 2003 and 2022. Compared to treatment as usual (TAU), only cognitive behavioral therapy (CBT) (SMD - 0.60, CI95% [- 1.0, - 0.17]) leads to a significant reduction in depression scores. Other interventions did not improve depression scores significantly. Our results show that for patients with HF and depression, CBT can significantly improve measures of depression, being the most efficacious treatment.

Emerging Outlook on Personalized Neuromodulation for Depression: Insights From Tractography-Based Targeting

BackgroundDeep brain stimulation has shown promise in treating individual patients with treatment-resistant depression, but larger-scale trials have been less successful. Here, we created what is, to our knowledge, the largest meta-analysis with individual patient data to date to explore whether the use of tractography enhances the efficacy of deep brain stimulation for treatment-resistant depression. MethodsWe systematically reviewed 1823 articles, selecting 32 that contributed data from 366 patients. We stratified the individual patient data based on stimulation target and use of tractography. Using 2-way type III analysis of variance, Welch’s 2-sample t tests, and mixed-effects linear regression models, we evaluated changes in depression severity 1 year (9–15 months) postoperatively and at last follow-up (4 weeks to 8 years) as assessed by depression scales. ResultsTractography was used for medial forebrain bundle (MFB) (n = 17 tractography/32 total), subcallosal cingulate (SCC) (n = 39 tractography/241 total), and ventral capsule/ventral striatum (n = 3 tractography/41 total) targets; it was not used for bed nucleus of stria terminalis (n = 11), lateral habenula (n = 10), and inferior thalamic peduncle (n = 1). Across all patients, tractography significantly improved mean depression scores at 1 year (p < .001) and last follow-up (p = .009). Within the target cohorts, tractography improved depression scores at 1 year for both MFB and SCC, though significance was met only at the α = 0.1 level (SCC: β = 15.8%, p = .09; MFB: β = 52.4%, p = .10). Within the tractography cohort, patients with MFB tractography showed greater improvement than patients with SCC tractography (72.42 ± 7.17% vs. 54.78 ± 4.08%) at 1 year (p = .044). ConclusionsOur findings underscore the promise of tractography in deep brain stimulation for treatment-resistant depression as a method for personalization of therapy, supporting its inclusion in future trials.

Abstract 7462: Interventional dietary saffron drives antitumor immunity inInterventional dietary saffron drives antitumor immunity in high risk colorectal cancer IBD Patients, A Multisite Clinical Trial Study

Abstract Background: Inflammatory polyps in patients with Inflammatory Bowel Disease (IBD) pose a significant risk for colorectal cancer (CRC). Dietary interventions targeting anti-tumor immunity are crucial in mitigating this risk. Aim: We investigated saffron's anti-inflammatory effects in IBD patients due to the high prevalence of polyps, aiming to prevent CRC. Methods: The study retrospectively evaluated 485 colitis patients (70 IBD, 415 NIC) from Howard University Hospital, through colonoscopy, pathology, and clinical reports evaluations. At Howard University, three UC patients received 50mg of saffron twice daily for 8 weeks, with two cycles. Inflammatory markers, stool calprotectin, and cytokines were assessed. Similar saffron trials were conducted at Yazd University (30 UC patients) and Egypt University (11 UC patients). Results: Patients with inflammatory bowel disease (IBD) were found to have a 15.7% prevalence of polyps compared to 8.2% in Non-inflammatory colitis patients. Among IBD patients, those with ulcerative colitis had more polyps (27%) than those with Crohn's disease (5%). In a multisite clinical trial, Saffron treatment improved various health indicators, including Partial MayoScore and quality of life. In the study (HU site), pro-inflammatory cytokines decreased, anti-inflammatory markers increased, and fecal calprotectin levels dropped significantly after saffron treatment. Saffron also led to changes in gut bacteria composition. Importantly, no adverse events were reported in the study participants. In one group of patients (Yazd study), saffron treatment led to significant improvements in depression scores, disease severity, and inflammation markers. In another site (Egypt study), 50% of saffron-treated patients showed improvement in markers related to disease severity, inflammation, and quality of life. Conclusion: Saffron supplementation, alongside standard treatments, shows promise in reducing local and systemic inflammation in IBD patients and may reduce the risk of developing inflammatory polyps and hence CRC. This safe and feasible intervention warrants further exploration as an inflammation-driven CRC preventive strategy. Citation Format: Hassan Ashktorab, Roham Salmanroghani, Hassan Salmanroghani, Reza Oskrochi, Mudasir Rashid, Adeyinka Laiyemo, Suryanarayana Reddy Challa, Philip Oppong-Twene, Nasrin Farjana, Angesom Kibreab, Holden Maeker, Amr Amin, Amal Ahmed Mohamed, Amr Elsayed, Zaki Mohamed Zaki, Omima Mohamed, Alshymaa Hassnine, Salma Saed, Soha Hassanin, Farshad Aduli, Lakshmi Gayathri Chirumamilla, Hassan Brim. Interventional dietary saffron drives antitumor immunity inInterventional dietary saffron drives antitumor immunity in high risk colorectal cancer IBD Patients, A Multisite Clinical Trial Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7462.

The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis.

Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

The impact of a virtual mind-body program on symptoms of depression and anxiety among international English-speaking adults with neurofibromatosis.

The neurofibromatoses (NFs) are a set of incurable genetic disorders that predispose individuals to nervous system tumors. Although many patients experience anxiety and depression, there is little research on psychosocial interventions in this population. The present study examined the effects of a mind-body intervention on depression and anxiety in adults with NF. This is a secondary analysis of the Relaxation Response Resiliency Program for NF (3RP-NF), an 8-week virtual group intervention that teaches mind-body skills (e.g., relaxation, mindfulness) to improve quality of life. Participants were randomized to 3RP-NF or the Health Enhancement Program for NF (HEP-NF) consisting of health informational sessions and discussion. We evaluated depression (PHQ-9) and anxiety (GAD-7) at posttreatment, 6 months, and 12 months. Both groups improved in depression and anxiety between baseline and posttest, 6 months, and 12 months. The 3RP-NF group showed greater improvements in depression scores from baseline to 6 months compared with HEP-NF and with lower rates of clinically significant depressive symptoms. There were no between-group differences for anxiety. Both interventions reduced distress and anxiety symptoms for individuals with NF. The 3RP-NF group may be better at sustaining these improvements. Given the rare nature of NF, group connection may facilitate reduced distress.

Evaluating cognitive behavioral therapy as a solution for postnatal depression in economically disadvantaged regions.

Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care. A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention. Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen's d = 0.1, 95% CI = - 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen's d = - 1.9, 95% CI = - 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294-303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference. CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings.

Comparing the efficacy of electronic cognitive behavioral therapy to medication and combination therapy for generalized anxiety disorder: a quasi-experimental clinical trial.

Generalized anxiety disorder (GAD) is a debilitating mental health disorder with first-line treatments include cognitive behavioral therapy (CBT) and pharmacotherapy. CBT is costly, time-consuming, and inaccessible. Electronic delivery (e-CBT) is a promising solution to address these barriers. However, due to the novelty of this intervention, more research testing the e-CBT efficacy independently and in conjunction with other treatments is needed. This study investigated the efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD. This study employed a quasi-experimental design where patients selected their preferred treatment modality. Patients with GAD were enrolled in either e-CBT, medication, or combination arms. The 12-week e-CBT program was delivered through a digital platform. The medications followed clinical guidelines. The efficacy of each arm was evaluated using questionnaires measuring depression, anxiety, and stress severity, as well as quality of life. There were no significant differences between arms (N e-CBT = 41; N Medication = 41; N Combination = 33) in the number of weeks completed or baseline scores. All arms showed improvements in anxiety scores after treatment. The medication and combination arms improved depression scores. The e-CBT and Combination arms improved quality of life, and the combination arm improved stress scores. There were no differences between the groups in depression, anxiety, or stress scores post-treatment. However, the combination arm had a significantly larger improvement in quality of life. Gender and treatment arm were not predictors of dropout, whereas younger age was. Incorporating e-CBT on its own or in combination with pharmaceutical interventions is a viable option for treating GAD. Treating GAD with e-CBT or medication appears to offer significant improvements in symptoms, with no meaningful difference between the two. Combining the treatments also offer significant improvements, while not necessarily superior to either independently. The findings suggest that all options are viable. Taking the patient's preferred treatment route based on their lifestyle, personality, and beliefs into account when deciding on treatment should be a priority for care providers.

P1: Dosing and treatment outcomes of rTMS for treatment-resistant depressed older adults in a naturalistic outpatient clinic population.

Introduction:Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.Methods:This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.Results:Eighty-nine patients were included for analysis: Group 1: &gt;55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: &lt;55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A &gt;50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps &lt; .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a &gt;50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps &lt; .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.Conclusion:With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.

Preliminary evidence that ketamine alters anterior cingulate resting-state functional connectivity in depressed individuals

Activity changes within the anterior cingulate cortex (ACC) are implicated in the antidepressant effects of ketamine, but the ACC is cytoarchitectonically and functionally heterogeneous and ketamine’s effects may be subregion specific. In the context of a double-blind randomized placebo-controlled crossover trial investigating the clinical and resting-state fMRI effects of intravenous ketamine vs. placebo in patients with treatment resistant depression (TRD) vs. healthy volunteers (HV), we used seed-based resting-state functional connectivity (rsFC) analyses to determine differential changes in subgenual ACC (sgACC), perigenual ACC (pgACC) and dorsal ACC (dACC) rsFC two days post-infusion. Across cingulate subregions, ketamine differentially modulated rsFC to the right insula and anterior ventromedial prefrontal cortex, compared to placebo, in TRD vs. HV; changes to pgACC-insula connectivity correlated with improvements in depression scores. Post-hoc analysis of each cingulate subregion separately revealed differential modulation of sgACC-hippocampal, sgACC-vmPFC, pgACC-posterior cingulate, and dACC-supramarginal gyrus connectivity. By comparing rsFC changes following ketamine vs. placebo in the TRD group alone, we found that sgACC rsFC was most substantially modulated by ketamine vs. placebo. Changes to sgACC-pgACC, sgACC-ventral striatal, and sgACC-dACC connectivity correlated with improvements in anhedonia symptoms. This preliminary evidence suggests that accurate segmentation of the ACC is needed to understand the precise effects of ketamine’s antidepressant and anti-anhedonic action.

Outcomes at the Motherhood Center: A Comparison of Virtual and On-Site Versions of a Specialized Perinatal Partial Hospitalization Program.

Remotely administered mental health care is becoming increasingly common for treatment of a range of psychiatric disorders; however, there is a dearth of literature overviewing direct comparisons between remote and in-person interventions for treatment of Perinatal Mood and Anxiety Disorders (PMADs). The sudden advent of the Covid-19 pandemic in New York City forced an abrupt conversion for an intensive day treatment program for new mothers with PMADs, from an on-site to a remote program. The current report compares outcomes of 81 women who completed the program in-person to those of 60 women who completed the program remotely. Improvement in depression scores was statistically superior in the remote program, and improvement in mother-infant bonding was statistically equivalent between the on-site and remote programs. These findings indicate that specialized partial hospitalization treatment for individuals with moderate to severe psychiatric illness can be effectively provided via telehealth, thus offering improved convenience, accessibility, and safety without compromising care. We conclude that remotely administered group psychotherapy is an effective intervention for women with moderate to severe PMADs.

Factors of the changes in depressive symptoms among retirees: a 3-year follow-up study in Taiwan

Abstract Background Depression is a critical mental problem for middle-aged and older adults. In addition, retirement and its adjustment may further affect their physical and psychological health. Hence, this study aims to explore the risk and protective factors associated with the changes in depressive symptoms among retirees. Methods A 3-year follow-up study was designed to examine the factors affecting the changes in depressive symptoms in retired people. A total of 2,379 participants aged 50 to 74 years were recruited from the Taiwan Health and Retirement Study during 2015-2019 (two waves). Three types of study variables were included: (i) sociodemographic factors: 9 items, (ii) health-related variables: 7 items, and (iii) psychosocial factors: 6 items. The changes in the 10-item CESD score after three years were measured as the outcome variable. The score change was divided into three groups: maintenance, deterioration, and improvement. Multinomial logistic regressions were used to analyze risk and protective factors related to changes in depressive symptoms in retirees. Results After adjusting for all covariates, this study found that retirement time ≥ 10 years, unskilled occupation before retirement, and having stressful life events after retirement may worsen depression scores three years later. Instead, getting a good night's sleep prevented worsening depression scores after three years. For the improvement group, the results showed that being a volunteer could improve the depression score; however, living alone and having poor health may hinder improving depression scores after three years. Furthermore, we found that factors associated with changes in depressive symptoms showed gender differences. Conclusions Future interventions to prevent depression should consider the diverse needs of different risk and protective factors and gender differences. Key messages • Retirees over ten years, with unskilled occupations and recent stressful events, were at high risk for depression. However, good sleep quality can help prevent depression. • For male retirees, regular physical activity was an enabling factor for improving depression, whereas women benefited from social connections.

Efficacy and safety of celecoxib monotherapy for treatment of moderate depressive symptoms following COVID-19 infection: A randomized, double-blind, placebo-controlled trial

ObjectiveCelecoxib, a nonsteroidal anti-inflammatory agent, was found to be an effective add-on treatment for unipolar and bipolar depression. We investigated the potential beneficial effect of celecoxib monotherapy on depressive symptoms after Coronavirus disease (COVID-19). MethodsThis was a randomized, double-blind, placebo-controlled clinical trial investigating the therapeutic effects of celecoxib monotherapy in patients with moderate depressive symptoms following COVID-19 infection. Patients were randomized to receive either a celecoxib capsule (100 mg) twice daily or a placebo capsule twice daily for 6 weeks. Participants were assessed with the Hamilton Depression Rating Scale (HDRS) and the side effect checklist at baseline and weeks 3 and 6. ResultsA total of 62 patients were included. GLM repeated-measures showed a significant effect of time × treatment (F = 12.95, df = 1.98, p < 0.001) for celecoxib, suggesting superior improvement of depressive symptoms in celecoxib compared to placebo from baseline to the study endpoint. HDRS scores in the celecoxib group showed a greater decline from baseline to both week 3 (t = 4.12, p < 0.001, Cohen's d = 1.10) and week 6 (t = 4.76, p < 0.001, Cohen's d = 1.27), compared to the placebo group. Rate of response to treatment (70% vs 9%, p < 0.001) and remission (67% vs 0%, p < 0.001) was significantly higher in celecoxib compared to the placebo group at week 6. Adverse event frequencies were not significantly different between the two groups. ConclusionWe demonstrated that treatment with celecoxib significantly improved depression scores of patients with depressive symptoms following COVID-19 infection. Further trials with larger sample sizes and longer study periods should assess our findings before any suggestion for clinical use.The trial was prospectively registered at the Iranian registry of clinical trials (www.irct.ir; registration number: IRCT20090117001556N142).

A Systematic Review of Positive Psychology Interventions (PPIs) to Improve the Health Behaviours, Psychological Wellbeing and/or Physical Health of Police Staff

This review aimed to assess the use of positive psychology interventions (PPIs), such as using positive mantras, expressive writing, or gratitude diaries, to improve the health behaviours, psychological wellbeing and/or physical health of police staff. The review was registered on PROSPERO before 16 electronic databases were searched for published articles between January 1999 and February 2022. Included studies offered PPIs to improve the physical health (body mass index, blood pressure), psychological well-being (stress, anxiety, mood, emotion, depression, self-efficacy), or health behaviours (physical activity, sitting times, dietary habits, alcohol, or tobacco use) of police staff. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias of included papers. The initial search yielded 4560 results; with 3385 papers remaining after duplicates were removed. Of these, 15 studies were included in the final review. Intervention types included mindfulness-based resilience training (n = 11), physical or wellness practice classes (n = 1), role-play and scenario-based interventions (n = 2) and expressive writing (n = 1). Mindfulness-based interventions improved many psychological wellbeing facets such as anxiety, depression, negative affect and quality of life. Limited improvements were observed for some health behaviours such as alcohol consumption and in self-reported general health. Expressive writing and role-play-based interventions were effective in reducing stress and anxiety, however, improvement in depression scores were inconsistent across studies. Positive psychology interventions are promising to support the health and wellbeing of police staff. Future research should investigate their mechanisms of action to support future innovation in support for police wellbeing.

The Effects of Light Therapy for Depression in Dementia: A Systematic Review and Meta-Analysis.

Depression is one of the most common symptoms in patients with dementia. This meta-analysis aimed to evaluate the effect of light therapy on depression associated with dementia by using a single scale. Published studies based on the terms including "Dementia", "depression", and "Phototherapy" were searched. Web of Science, PubMed, Embase, CiNii, CNKI, Wanfang Database, and China Biology Medicine disc were adopted to collect randomized controlled studies or cross-controlled studies using the Cornell Scale for Depression in Dementia (CSDD) until February 2022. GRADE and Review Manager Version 5.4.1 were employed to assess the risk of bias. A meta-analysis was conducted by R 4.0.2 software based on the changes in CSDD scores. A total of 1,055 studies were retrieved from the databases, and six studies were included after screening. Some 406 people with dementia were included with an average age of over 80 years. Forest plot results showed that light intervention improved depression scores of dementia patients (MD = -2.59, 95% CI: -4.46 to -0.71), and light intensity less than 1,000 lux improved depression symptoms of dementia patients (MD = -2.76, 95% CI: -4.55 to -0.97). An intervention that lasted 8 to 12 weeks was the most effective (MD = -3.77, 95% CI: -6.93 to -0.60), and non-stable interventions such as ceiling LED lights exerted more positive effects (MD = -2.12, 95% CI: -3.38 to -0.85). The overall results of the meta-analysis suggested that light intervention can improve the depressive symptoms of older patients with dementia.

Preoperative Depression Is Associated With Increased Short-term Complications But Equivalent Long-term Outcomes in Total Knee Arthroplasty.

Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA. A total of 258 patients underwent primary TKA at a tertiary academic center between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. Patients with preoperative PROMIS depression scores of 55 or greater were considered PROMIS depressed (PD) and patients with scores less than 55 were considered not PROMIS depressed (ND). The primary outcomes were changes in PROMIS scores. Secondary outcomes included total and daily mean morphine milligram equivalents (MME) received during admission as well as 90-day hospital readmission and 2-year all-cause revision rates. There were 66 (25.58%) patients in the PD group and 192 (74.42%) in the ND group. Patients in the PD group had improved depression scores at all follow-up intervals (P<.001) and decreased pain scores at 1 year (P=.016). Both groups experienced similar changes in function scores at each follow-up interval. Patients in the PD group had higher total (P=.176) and daily (P=.433) mean MME use while admitted. Ninety-day hospital readmissions were higher in the PD group (P=.002). There were no differences in 2-year revision rates (P=.648). Preoperative PROMIS-depression scores of 55 or greater do not negatively impact postoperative function, depression, or pain, and patients with these scores have greater improvement in depression and pain at certain intervals. Patients in the PD group had higher readmission rates. [Orthopedics. 2024;47(1):40-45.].

Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal models. In this study, 98 unipolar depressed adults who failed at least one antidepressant medication were randomized 2:1 to a single infusion of intravenous ketamine (0.5 mg/kg) or vehicle (saline) and completed diffusion tensor imaging (DTI) assessments at pre-infusion baseline and 24-h post-infusion. DTI mean diffusivity (DTI-MD), a putative marker of microstructural neuroplasticity in gray matter, was calculated for 7 regions of interest (left and right BA10, amygdala, and hippocampus; and ventral Anterior Cingulate Cortex) and compared to clinical response measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms-Self-Report (QIDS-SR). Individual differences in DTI-MD change (greater decrease from baseline to 24-h post-infusion, indicative of more neuroplasticity enhancement) were associated with larger improvements in depression scores across several regions. In the left BA10 and left amygdala, these relationships were driven primarily by the ketamine group (group * DTI-MD interaction effects: p = 0.016–0.082). In the right BA10, these associations generalized to both infusion arms (p = 0.007). In the left and right hippocampus, on the MADRS only, interaction effects were observed in the opposite direction, such that DTI-MD change was inversely associated with depression change in the ketamine arm specifically (group * DTI-MD interaction effects: p = 0.032–0.06). The acute effects of ketamine on depression may be mediated, in part, by acute changes in neuroplasticity quantifiable with DTI.

Access for Cancer Caregivers to Education and Support for Shared Decision Making (ACCESS) intervention: a cluster cross-over randomised clinical trial

ObjectivesThe purpose of this study was to test an intervention named ACCESS (Access for Cancer Caregivers to Education and Support for Shared Decision Making). The intervention uses private Facebook support...

Cariprazine add-on for resistant bipolar depression: preliminary results from an italian real-world experience

IntroductionDepressive episodes represent the most frequent mood alteration in bipolar disorder (BD). Persistent depressive episodes and subsyndromic depressive symptoms often lead to poor quality of life and increase suicide risk. Recent studies have also shown that BD patients with a history of predominant depressive episodes generally show poorer response to pharmacological treatments. Although not specifically approved in Italy for use in bipolar depression, the scientific literature produced so far suggests the possible use of cariprazine in clinical conditions of bipolar depression that do not respond to conventional treatments.ObjectivesThe aim of the study was to evaluate, in a real-world multicentric Italian clinical setting, the efficacy and safety of cariprazine augmentation strategy in a sample of patients suffering from treatment-resistant bipolar depression.Methods16 resistant bipolar depressed patients, whose resistance was defined according to The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder, were observed for 4 weeks after the add-on to previous mood stabilizing treatment of a cariprazine 1,5 mg fixed dose. Psychopathology at time 0 and at 1, 2, 3, and 4 weeks of treatment was evaluated using the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Young Mania Rating Scale and the Brief Psychiatric Rating Scale; safety and tolerability of the therapy was measured by the UKU Side Effect Rating Scale.ResultsClinical improvement induced by 1,5 mg cariprazine add-on was effective and well tolerated in the study sample. Improvement in depression scores started from the first week, reaching about 35% reduction within 15 days and almost 50% in the following weeks (mean HDRS score from 24,7 to 13,2, GLM r.m. p&lt;0,001); global psychopathology improved (mean BPRS score from 29,9 to 15,3 GLM r.m. p&lt;0,001) as well as anxiety symptoms (mean HARS score from 26,5 to 16,5 GLM r.m. p=0,003). No manic shifts were observed during the observation period and the treatment was generally well tolerated.ConclusionsDespite the small number of patients examined and the short term of observation, cariprazine could represent an effective and safe enhancement strategy for patients with bipolar depression resistant to common pharmacological treatments. Further studies on larger samples are needed to confirm these preliminary findings. In addition, a more prolonged observation would be appropriate to highlight whether the beneficial effect of cariprazine add-on persists over time.Disclosure of InterestNone Declared

A Community Partnership to Reduce Food Insecurity and Improve Patient-Reported Depression

Summary To address the growing prevalence of food insecurity and its adverse effects on health, health care organizations are partnering with community organizations to develop nutrition programs aimed at both reducing hunger and improving diet-related health. Although there has been little effort to document improvements in mental health outcomes among nutrition program recipients who receive support through a community–health care partnership, this study suggests a beneficial relationship. The Greater Boston Food Bank, a 501(c)3 organization that supplies food pantries and tracks food insecurity throughout eastern Massachusetts, has developed a mobile market (MM) intervention in partnership with community health centers (CHCs) and other community-based locations to provide free produce, dairy, and high-protein food to low-income residents of eastern Massachusetts in a farmers’ market–style environment, with the primary goal to reduce food insecurity. The data collected through the CHC partnership indicate that attendance at the MM was associated with improvement in depression score among CHC patients. All MM attendees experienced improvement in depression score with increased MM utilization, but the biggest effect was for patients with a diagnosis of depression at baseline. This partnership experience demonstrates that interventions developed by health care–community partnerships may have benefits for program participants beyond the primary goal of the program. During the study period of more than 3 years, for all patients in the study, each MM visit was associated with a 0.05-point decrease in the subsequent nine-item Patient Health Questionnaire (PHQ-9) score (95% confidence interval [CI], −0.08 to −0.02), which is a measure of depression on a scale of 0 to 27. Among those who had a diagnosis of moderate or severe depression before the MM intervention (PHQ-9 higher than 9), each MM visit was associated with a 0.27-point decrease in the subsequent PHQ-9 score (95% CI, −0.33 to −0.20). Mean attendance at the MM for patients with a diagnosis of depression was 6.7 visits, which translates to a predicted 1.8-point reduction in PHQ-9 score per patient during the study period.