Depressive Episode Research Articles

Cognitive Impairment and Risk of Depressive Episodes from a Bipolar Spectrum Perspective: A Case-Control Study in Older Adults during the COVID-19 Lockdown

Background: A wide range of conditions, including mixed depressive symptoms, hyperactivity, cognitive impairment (CI) might be expressions of Bipolar Spectrum Disorder (BSD) according to the neo-Kraepelinian perspective, even in advanced age. CI, which has a high prevalence in the elderly population, when it occurs in comorbidity with depression further hinders therapy response and functional ability. The present study aims to explore risk factors associated with CI in elderly individuals experiencing a depressive episode during lockdown a period marked by significant stressors and rhythm disruption. Methods: A case-control study analyzed data from a previous RCT (secondary analyses) on elderly individuals living at home, assessing depressive symptoms, cognitive performance, hyperactivity, and hypertension before (T0) and during lockdown (T1). Results: Participants with lower pre-pandemic cognitive performance were more prone to lockdown depression compared to those with higher baseline function (F = 6.074; p = 0.016). Among those experiencing lockdown depression without prior depression, those with low cognitive performance were more prevalent than the control group without depression (OR = 11.8; p = 0.015). Conclusion: This study highlights a potentially vulnerable subgroup within the elderly population that requires targeted interventions and support during stressful events. Future research should explore the underlying mechanisms linking cognitive decline and depression in older adults, particularly those with a possible bipolar spectrum predisposition.

The effect of age on the relationship between negative life events and current and new depressive episodes: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundThere is scarce data concerning the relationship between negative life events (NLEs)* and current and new depressive episodes by age. MethodsCross-sectional (baseline) and prospective analyses (4-year/8-year follow-ups) were performed in 15,105 civil servants in 6 cities in Brazil classified according to age strata at baseline: 1st(35–44), 2nd(45–54), 3rd(55–64), and 4th(65–74) years. The independent variable was NLEs in the last year (robbery, hospitalization, death of a relative, financial hardship, and rupture of a love relationship) collected at baseline. The dependent variable was depressive episodes assessed at baseline (current), and 4-year/8-year follow-ups (new). We built logistic (Odds Ratio[OR];95 % Confidence Interval[CI]) in the cross-sectional analysis and Poisson regression models (Relative Risk[RR], [CI]) in the prospective analysis. ResultsRobbery, hospitalization, financial hardship, rupture of a relationship were associated with current depressive episodes concentrated in the 35–44 age range, while for new depressive episodes, the association of hospitalization, death of a relative, and financial hardship were concentrated in the 45–54 age stratum. Financial hardship was associated with current depressive episodes in all age-strata: 1st: OR, 2.77(CI, 1.83–4.19); 2nd: OR, 1.71(CI, 1.26–2.34); 3rd: OR, 1.68(CI,1.15–2.46); 4th, OR, 4.07(CI, 1.24–13.34), and new depressive episodes: 1st: RR, 1.45(CI, 1.09–1.93); 2nd RR, 1.46(CI: 1.15–1.84); 3rd: RR, 1.97(CI, 1.38–2.82). Rupture of a relationship was associated only with current depressive episode, while death of a relative only with new depressive episode. LimitationWe cannot rule out the possibility of recall bias, since NLEs` information was self-reported. ConclusionThe association between NLEs with depressive episodes was concentrated in youngers.

Case identification and healthcare utilization in the years prior to a first mania diagnosis

BackgroundThere is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets. MethodsUsing the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months. ResultsAmong 4806 individuals aged 15–35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15–35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis. LimitationsStudy was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds. ConclusionsCareful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease.

Emerging suicidal ideation in a bipolar patient after taking pregabalin: a case report

Bipolar disorder is a severe mental illness and often occurs with comorbidities like anxiety or alcohol abuse. Thus pregabalin could be a promising drug. We present a case report of a 37-year-old woman with bipolar II disorder suffering from a depressive episode with features of anxiety and increased alcohol consumption. The patient was started on quetiapine as monotherapy. After a few days of add-on pregabalin, we observed suicidal ideations and self-harming behaviour, although expression of anxiety as well as alcohol consumption showed a decrease. When we stopped pregabalin and increased the dosage of quetiapine, suicidal behaviour almost disappeared. In the relevant literature, there is disagreement on the use of pregabalin. On the one hand, pregabalin is described as a safe and well-tolerated drug, and on the other hand, there are also concerns about the suicidal effect of anticonvulsants. In conclusion, we recommend the cautious use of pregabalin and other anticonvulsant drugs in patients with affective disorder. There could be a promising effect on the comorbidities but the effect on mood remains still unclear.

Antenatal and postpartum depression in women who conceived after infertility treatment: a longitudinal study

ABSTRACT Background Although the association between a history of infertility treatment and perinatal depression has been investigated, most research has been cross-sectional and has not used diagnostic assessment tools. Aims This study investigates longitudinally the association between a history of infertility treatment and perinatal depression using WHO-Composite International Diagnostic Interview 3.0 (WHO-CIDI 3.0) and the Edinburgh Postnatal Depression Scale (EPDS). Methods This study used data (N = 2,435) from the control group of a randomised controlled trial on a sample of pregnant women. Survival analysis was used to examine the influence of infertility treatment on perinatal depressive disorder evaluated by WHO-CIDI 3.0. The EPDS scores at four time points (T1 [baseline]: 18 ± 2 weeks gestation, T2: 32 weeks gestation, T3: 1 week postpartum, T4: 3 months postpartum) were analysed using generalised mixed model analysis. Results The risk of experiencing a major depressive episode evaluated by WHO-CIDI 3.0 did not significantly differ between women conceiving through infertility treatment and those conceiving spontaneously (adjusted hazard ratio = 1.64, p = 0.109). The longitudinal analysis demonstrated that EPDS scores significantly increased at T3 and T4 among women conceiving through infertility treatment compared with those conceiving spontaneously (adjusted estimates of fixed effect from T1 to T3: 1.17, p < 0.01; from T1 to T4: 0.71, p = 0.022). Conclusion Women conceiving through infertility treatment were not found to have a higher risk of diagnosable perinatal depressive disorder than those conceiving naturally. However, a history of infertility treatment can marginally increase sub-clinical postpartum depressive symptoms.

Atlas-based structural analysis of prefrontal cortex atrophy in major depressive disorder: Correlations with severity and episode frequency

BackgroundCurrent models of major depressive disorder (MDD) primarily focus on the structural and functional changes in key prefrontal areas responsible for emotional regulation. Among these regions some sections such as the dorsal prefrontal area, has received limited attention regarding its structural abnormalities in MDD. This study aims to evaluate volumetric abnormalities in brain regions associated with markers of depression severity and episode frequency. MethodsThe study included 33 MDD patients and 33 healthy subjects. Using an atlas-based method, we measured the volumes of several key brain regions based on MRI data. The regions of interest included prefrontal and posterior sections of the middle frontal gyrus (MFG) and superior frontal gyrus (SFG). Additionally, we evaluated the volumes of the dorsal anterior cingulate cortex (dACC), perigenual (rostral) anterior cingulate cortex (pgACC), subgenual cingulate cortex (sgACC), posterior cingulate cortex (PCC), hippocampus (HPC), and parahippocampus (paraHPC). Hamilton Depression Scale (HAM-D) scores and count of the depressive episodes of patients were also obtained. A regression analysis with sex as the confounding factor has been made. ResultsAnalysis of covariances, controlling for sex, showed significant atrophy in the sgACC in the depression group: F(1, 63) = 4.013, p = 0.049 (left) and F(1, 63) = 8.786, p < 0.004 (right). Poisson regression, also controlling for sex, found that each additional depressive episode was associated with a significant reduction in left posterior MFG volume (0.952 times, 95 % CI, 0.906 to 1.000; p = 0.049). ConclusionsFindings in this study highlight the structural abnormalities in MDD patients in correlation to either current depression severity or chronicity of the disease.

The effect of intranasal (R,S)-ketamine on symptoms of fatigue in severe major depressive disorder or bipolar depression with and without comorbid alcohol use disorder: Results from a randomized, double-blind, placebo-controlled trial

BackgroundFatigue is a multidimensional condition that may overlap with depression. Initial studies found that fatigue responds in only a limited way to standard monoaminergic antidepressants and mood stabilizers but does respond positively to intravenous (IV) racemic (R,S)-ketamine (ketamine). However, IV ketamine's use is limited by cost and access barriers. To date, no study has evaluated intranasal (IN) ketamine in individuals with fatigue. This study sought to evaluate the anti-fatigue effects of a single 50 mg dose of IN ketamine in individuals with major depressive disorder (MDD) or bipolar depression (BDep), both with and without comorbid alcohol use disorder (AUD). MethodsTwenty-eight individuals with primary diagnoses of MDD or BDep I/II currently experiencing a depressive episode with active suicidality were enrolled; approximately 60 % had comorbid AUD. Changes in the NIH-Brief Fatigue Inventory (NIH-BFI) were assessed at baseline and at 4, 24, and 48 h post-treatment. ResultsThe group x time interaction for NIH-BFI score was significant (F = 3.44, p = 0.022), favoring IN ketamine over placebo. IN ketamine was well-tolerated with minimal adverse effects. LimitationsLimitations include the limited sample size, short duration, and single, fixed dose. ConclusionsIN ketamine appears to induce rapid anti-fatigue effects in individuals with severe MDD and BDep both with and without comorbid AUD. This suggests that IN ketamine holds potential as an alternative, rapid-acting, anti-fatigue option for different medical conditions.

The mediating role of family functioning between childhood trauma and depression severity in major depressive disorder and bipolar disorder

BackgroundChildhood trauma (CT) and family functioning exert significant influences on the course and long-term outcome of major depressive disorder (MDD) and bipolar disorder (BD) patients. Hence, we examined the intricate relationship between CT, family function, and the severity of depressive episodes in MDD and BD patients. Methods562 patients with depressive episodes (336 MDD and 226 BD) and 204 healthy controls (HCs) were included in this retrospective study. The 17-item Hamilton Depression Rating Scale (HAMD-17), Childhood Trauma Questionnaire (CTQ), and Family Adaptability and Cohesion Evaluation Scale (FACES II-CV) were assessed. Pearson correlation analysis and mediation analysis were performed. ResultsCT had both a direct and indirect impact on depression severity in MDD and BD groups. In MDD, family adaptability mediated the impact of all CT subtypes on depression severity (Effect = 0.113, [0.030, 0.208]). In BD, family cohesion played a mediating role between emotional neglect (EN) and HAMD-17 scores (Effect = 0.169, [0.008, 0.344]). Notable differences were observed in onset age, illness duration, episode frequency, family history, and CT subtypes between MDD and BD (P < 0.05). LimitationsThis study has several limitations including recall bias, lack of objective family functioning measures, small sample size, and cross-sectional design. ConclusionsFamily functioning mediated the impact of CT on depressive symptoms severity in MDD and BD patients. MDD patients with a history of CT exhibited reduced family adaptability, while BD patients with a history of EN had weaker familial emotional bonds. Our findings highlighted the importance of family-focused preventive interventions in mitigating the long-term effects of CT.

Exploring the reality of seafarers' deaths and injuries and preventive measures from the cases of overwork-related disorders

Till date, only few studies have detailed the reality of overwork-related disorders among seafarers. Therefore, in this study, we aimed to evaluate the prevalence of overwork-related disorders among seafarers and assess factors such as patient attributes, diseases diagnosed at the time of determination, workload factors, and other aspects, thereby suggesting relevant preventative measures. Among all the patients identified with overwork-related disorders from April 2010 to March 2017, 2,280 cases of cerebrovascular and cardiovascular diseases and 3,517 cases of mental disorders were selected. To identify seafarer-related cases, keywords related to seafarers were extracted. Subsequently, 33 cases of cardiovascular disease and 19 cases of mental disorders were obtained. The average age of the patients with cerebrovascular and cardiovascular diseases was 56.7 years; for those with mental disorders, it was 45.2 years. The patients were most commonly engaged in fishing, transportation, and postal services. Most patients were employed in the deck department or were captains. The most common types of vessels were fishing and cargo ships. Among the diseases diagnosed at the time of determination, cerebrovascular diseases accounted for 20 cases (60.6%) and cardiovascular diseases accounted for 13 cases (39.4%), with cerebral and myocardial infarctions being the most frequent conditions. Among mental disorders, "mood disorders" accounted for 7 cases (36.8%), and "neurotic disorders, stress-related disorders, and somatoform disorders" accounted for 12 cases (63.2%), with major depressive episodes, post-traumatic stress disorder, and adjustment disorders being the most common. The most common workload factor for patients with cerebrovascular and cardiovascular diseases was "long-term excessive work," and among non-workload factors, "long working hours" and "irregular working hours" were prevalent. For mental disorders, 8 cases were attributed to "extreme psychological stress." Specific events leading to these diseases included "interpersonal relationships," "experiencing accidents or disasters," and "work quantity and quality." Both cerebrovascular and cardiovascular diseases, as well as mental disorders, showed a notable aging trend among seafarers. Thus, measures that consider the characteristics of elderly workers, such as their physical function, are important. Additionally, as seafarers are distributed across various industries and occupations, measures should be specifically tailored to their industry and job type. Our study confirmed that long working hours and irregular working hours were prevalent in both cases. Therefore, there is an urgent need for further efforts to prevent and mitigate overwork-related deaths among seafarers, including organizational support from onshore workplaces and enhancement of medical and operational support using information and communication technology.

Full-spectrum efficacy of cariprazine across manic and depressive symptoms of bipolar I disorder in patients experiencing mood episodes: Post hoc analysis of pooled randomized controlled trial data

IntroductionPatients with bipolar I disorder may experience mood destabilization or treatment-emergent affective switch (TEAS) from one symptom pole to the other spontaneously or following treatment. Optimal treatment should address symptoms from both poles without precipitating destabilization. MethodsThese were pooled post hoc analyses of data from randomized, double-blind, placebo-controlled studies of cariprazine 3–12 mg/d for bipolar I mania (NCT00488618, NCT01058096, NCT01058668) and cariprazine 1.5 mg/d or 3 mg/d for bipolar I depression (NCT01396447, NCT02670538, NCT02670551). Changes from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 6 and Young Mania Rating Scale (YMRS) total score at week 3 were analyzed in each indication using a mixed-effects model for repeated measures. Percentages of patients with increasing levels of endpoint response and TEAS (bipolar mania = MADRS total score ≥ 19; bipolar depression = YMRS score ≥ 16) were determined. ResultsCariprazine significantly reduced manic and depressive symptoms in patients with bipolar I disorder mood episodes. In patients with a manic episode and up to mild baseline depressive symptoms, cariprazine also significantly reduced depressive symptoms. In patients with a depressive episode and manic symptoms in remission at baseline, numerical reduction (without statistical significance) in YMRS indicated no worsening of mania. In both indications, cariprazine-treated patients had numerically greater response rates (presenting symptom pole) than placebo-treated patients; lower percentages of cariprazine- than placebo-treated patients had TEAS at visits where data were collected. LimitationsPost hoc analysis. ConclusionResults suggested that cariprazine had full-spectrum efficacy across symptoms from both poles in patients with bipolar I disorder mood episodes; TEAS risk was low. Patient-level response suggested that improvement was clinically relevant.

Home-based transcranial direct current stimulation in bipolar depression: an open-label treatment study of clinical outcomes, acceptability and adverse events

BackgroundCurrent treatments for bipolar depression have limited effectiveness, tolerability and acceptability. Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation method that has demonstrated treatment efficacy for major depressive episodes. tDCS is portable, safe, and individuals like having sessions at home. We developed a home-based protocol with real-time remote supervision. In the present study, we have examined the clinical outcomes, acceptability and feasibility of home-based tDCS treatment in bipolar depression.ResultsParticipants were 44 individuals with bipolar disorder (31 women), mean age 47.27 ± 12.89 years, in current depressive episode of at least moderate severity (mean Montgomery Asberg Depression Rating Scale (MADRS) score 24.59 ± 2.64). tDCS was provided in bilateral frontal montage, F3 anode, F4 cathode, 2 mA, for 30 min, in a 6-week trial, for total 21 sessions, a follow up visit was conducted 5 months from baseline. Participants maintained their current treatment (psychotherapy, antidepressant or mood stabilising medication) or maintained being medication-free. A research team member was present by video conference at each session. 93.2% participants (n = 41) completed the 6-week treatment and 72.7% of participants (n = 32) completed the 5 month follow up. There was a significant improvement in depressive symptoms following treatment (mean MADRS 8.77 ± 5.37) which was maintained at the 5 month follow up (mean MADRS 10.86 ± 6.90), rate of clinical response was 77.3% (MADRS improvement of 50% or greater from baseline), and rate of clinical remission was 47.7% (MADRS rating of 9 or less). Acceptability was endorsed as “very acceptable” or “quite acceptable” by all participants. No participants developed mania or hypomania.ConclusionsIn summary, home-based tDCS with real-time supervision was associated with significant clinical improvements and high acceptability in bipolar depression. Due to the open-label design, efficacy findings are preliminary.Trial registrationClinicalTrials.gov number NCT05436613 registered on 23 June 2022 https//www.clinicaltrials.gov/study/NCT05436613.

Machine Learning-Driven Evaluation of Lithium and Valproate Combination Therapy in Bipolar Disorder

Background Bipolar disorder (BD) is characterized by recurrent episodes of mania and depression, requiring long-term mood stabilization. While lithium is a well-established treatment for BD, its efficacy can vary among individuals. Combination therapy with valproate has been explored to enhance treatment outcomes. Objective This case series aims to demonstrate the superior effectiveness of lithium and valproate combination therapy over lithium monotherapy in stabilizing mood in patients with bipolar disorder. Methods This retrospective study includes data from 2 patients diagnosed with bipolar disorder. Patients initially treated with lithium monotherapy who showed inadequate response were subsequently treated with a combination of lithium and valproate. Clinical assessments were conducted using the Mood Disorder Questionnaire (MDQ), Clinical Global Impression-Severity (CGI-S), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning (GAF) before and after combination therapy. Results Combination therapy with lithium and valproate significantly improved mood stability in patients compared to lithium monotherapy. On average, MDQ scores decreased from 22.4 to 8.3, CGI-S scores improved from 4.8 to 2.1, HDRS scores reduced from 25.6 to 9.7, and GAF scores increased from 50.3 to 75.4. These improvements were sustained over a followup period of 12 months. The combination of lithium and valproate provides superior mood stabilization in patients with bipolar disorder compared to lithium alone. These findings suggest that combination therapy should be considered in patients who do not achieve adequate symptom control with lithium monotherapy

Lamotrigine: A Safe and Effective Mood Stabilizer for Bipolar Disorder in Reproductive-Age Adults.

Lamotrigine belongs to the group of antiepileptic drugs and mood stabilizers, and its action is based on the selective blocking of voltage-deficient sodium channels. The effect of this mechanism is the stabilization of the presynaptic part of the neuronal membrane and subsequent inhibition of the secretion of the neurotransmitters glutamate and aspartate into the postsynaptic part of the neuron. Lamotrigine has been approved by the Food and Drug Administration for the maintenance treatment of adults with bipolar disorder since 1994. In the field of psychiatry, this medicine is also used off-label in the treatment of acute bipolar depression. Studies show promising effects of the use of lamotrigine in bipolar disorder type II with rapid phase change. Bipolar disorder is a common psychiatric problem that most often affects young adults. Lamotrigine is most effective in bipolar disorder in preventing depressive episodes, which dominate the clinical picture of this disease. The latest research focuses on extending its action, to include manic episodes. Lamotrigine, through an unexplained mechanism, can affect the immune system, causing Stevens-Johnson syndrome, hemophagocytic lymphohistiocytosis, and drug reaction with eosinophilia and systemic symptoms syndrome. These are rare, life-threatening adverse effects that require urgent intervention in the form of drug discontinuation and immunosuppressive treatment. Strict contraindications to the use of lamotrigine include sensitivity reactions accompanied by systemic symptoms. Phenotype testing enables screening of patients predisposed to serious hypersensitivity reactions. The aim of the article is to review the indications, contraindications, and adverse effects of lamotrigine in the treatment of bipolar disorder and depression.

Machine Learning-Driven Comparative Analysis of Quetiapine and Olanzapine for Managing Depressive Episodes in Bipolar Disorder

Background Bipolar disorder (BD) necessitates effective management of both manic and depressive episodes. Quetiapine and olanzapine are antipsychotic medications commonly used in the treatment of BD, but their relative efficacy as antidepressants is a topic of ongoing research. Objective This case series aims to evaluate the greater efficacy of quetiapine compared to olanzapine as an antidepressant in the treatment of bipolar disorder. Methods Two patients with bipolar disorder were treated with either quetiapine or olanzapine. Clinical assessments were conducted using the Mood Disorder Questionnaire (MDQ), Clinical Global Impression-Severity (CGI-S), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning (GAF) before and after the treatment. Results Quetiapine showed greater efficacy in reducing depressive symptoms and improving overall functioning compared to olanzapine. MDQ scores decreased, CGI-S scores improved, HDRS scores reduced, and GAF scores increased more significantly in the patient treated with quetiapine. Conclusion Quetiapine appears to be a more effective antidepressant than olanzapine in the treatment of bipolar disorder. These findings suggest that quetiapine could be considered a preferred option for managing depressive episodes in BD patients.

Machine Learning-Driven Evaluation of Antidepressant and Mood Stabilizer Combination Therapy in Bipolar Disorder

Background Bipolar disorder (BD) is characterized by recurrent episodes of mania and depression, requiring long-term mood stabilization. While mood stabilizers such as lithium and valproate are the cornerstone of BD treatment, the use of antidepressants in combination with mood stabilizers has been explored to enhance therapeutic outcomes, particularly in managing depressive episodes. Objective This case series aims to demonstrate the superior effectiveness of antidepressants combined with mood stabilizers over mood stabilizers alone in stabilizing mood in patients with bipolar disorder. Methods Two patients with bipolar disorder who initially received mood stabilizers monotherapy and exhibited suboptimal responses were subsequently treated with a combination of mood stabilizers and antidepressants. Clinical assessments were conducted using the Mood Disorder Questionnaire (MDQ), Clinical Global Impression-Severity (CGI-S), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning (GAF) before and after combination therapy. Results Combination therapy with antidepressants and mood stabilizers significantly improved mood stability in both patients compared to mood stabilizers alone. MDQ scores decreased, CGI-S scores improved, HDRS scores reduced, and GAF scores increased, with improvements sustained over a follow-up period of 12 months. Conclusion The combination of antidepressants and mood stabilizers provides superior mood stabilization in patients with bipolar disorder compared to mood stabilizers alone. These findings suggest that combination therapy should be considered in patients who do not achieve adequate symptom control with mood stabilizers monotherapy

Improving Person-Centered Depression Screening and Care in an Urban Faith-Based Community

Background:Depression is a common mental illness that increases the risk of suicide, substance abuse, and chronic pain. Nationally, 21 million adults have had one untreated depressive episode, 1.4 million people have had suicide attempts, and 1 death occurs every 10 minutes. Depression has an annual economic burden of $326 billion for the American economy.Objectives:This quality improvement project aims to review the existing literature on depression, audit local businesses, survey clients, and team members to identify a gap in practice and then collect and analyze data to draw conclusions and make recommendations based on the findings.Methods:This initiative used four Plan–Do–Study–Act rapid quality improvement cycles. Data were collected and analyzed, and the results were used to make iterative changes.Results:Depression screening improved by 90%, and 317 clients were screened over 8 weeks. Twenty-eight percent of those screened had depression and were engaged in managing their symptoms. Both screening and care improved, and the aim of 89% was met.Conclusions:This initiative bridged a gap in depression screening and care. It also demonstrated a positive outcome, had the potential for sustainability, and spread to other faith communities.Implications for Nursing:A system should be put in place for depression screening, care, and referrals.

Prevalence and Risk by Age and Sex of Sleep Dysregulation and Depressive Episodes in Bipolar and Depressive Disorders in a Community Survey in Sardinia, Italy.

Background/Objectives: Sleep disturbances often accompany mood disorders and persistent insomnia after mood symptoms have resolved may be a marker of poor outcome. The association between sleep symptoms and mood disorders seems to change with age and sex. This study aims to assess the frequency of depressive episodes and sleep disorders in the general population through an agile screening questionnaire and to evaluate the association of depressive episodes and sleep symptoms by sex and age categories. Methods: 774 women and 728 men from Sardinia aged > 16 years old were enrolled. The Patient Health Questionnaire (PHQ-9) was administered through a computer-assisted telephonic interview. Results: The frequency of depressive episodes was double in women (10.6% vs. 4.4%; p < 0.0001), with the highest values in women > 75 yo (17.4%). The frequency of sleep dysregulation was double in women (18.7% vs. 9.6%; p < 0.0001), with the highest values in women > 75 yo (35.9%) and the lowest in the group of men > 75 yo. The group of young males showed the lowest frequency of depressive episodes (1.4%) and a frequency of sleep dysregulation (9.1%) similar to that of the other groups of age and sex. Sleep dysregulation without depressive episodes presented a higher distribution in the elderly, both in males (20.7%) and in females (18.5%). No significative differences were found across sex and age groups in the distribution of depressive episodes without sleep dysregulation. Conclusions: The use of an agile screener such as PHQ9 in the general population and/or in populations at risk can be a valuable tool in finding those individuals in whom sleep dysregulation may represent an early warning signal, one that may be thoroughly evaluated to identify and treat possible sleep disorders early.

A systematic review and network meta-analysis of psychological, psychosocial, pharmacological, physical and combined treatments for adults with a new episode of depression

Various effective treatments for depression exist. We aimed to identify the most effective first-line treatments for new episodes of less and more severe depression (defined by depression scale cut-off scores), to update NICE guidance on the management of Depression in Adults in England. Systematic review and network meta-analysis of randomised controlled trials (RCTs) published up to June 2020 (PROSPERO registration number CRD42019151328). We analysed interventions by class and individually. The primary efficacy outcome was depressive symptom change (expressed as standardised mean difference [SMD]). The review for this outcome was updated in November2023. We included 676 RCTs, 105,477 participants and 63 treatment classes. For less severe depression, group cognitive/cognitive behavioural therapy (CT/CBT) class was efficacious versus treatment as usual [TAU], the reference treatment for this population [SMD-1.01 (95% Credible Interval [CrI]-1.76;-0.06)]. For more severe depression, efficacious classes versus pill placebo (reference treatment for this population) included combined individual CT/CBT with antidepressants [-1.18 (-2.07;-0.44)], individual behavioural therapies [-0.86 (-1.65;-0.16)], combined light therapy with antidepressants [-0.86 (-1.59;-0.12)], combined acupuncture with antidepressants [-0.78 (-1.12;-0.44)], individual CT/CBT [-0.78 (-1.42;-0.33)], mirtazapine [-0.35 (-0.48;-0.22)], serotonin and norepinephrine reuptake inhibitors [-0.32 (-0.43;-0.22)], tricyclic antidepressants [-0.29 (-0.50;-0.05)], and selective serotonin reuptake inhibitors [-0.24 (-0.32;-0.16)]. Additional treatments showed evidence of efficacy at the intervention level. Evidence for less and more severe depression was of low and low-to-moderate quality, respectively. In the 2023 update, group yoga and self-help without support emerged as efficacious for less severe depression. For more severe depression, combined group exercise with antidepressants emerged as efficacious, whereas combined light therapy with antidepressants failed to remain efficacious. Group CT/CBT (and possibly group yoga and self-help) appears efficacious in less severe depression, whereas antidepressants do not show evidence of effect. Combined antidepressants with individual CT/CBT, acupuncture and, possibly, group exercise, individual psychological therapies (behavioural therapies, CT/CBT) alone, and antidepressants alone appear efficacious in more severe depression. Quality of evidence, cost-effectiveness, applicability and implementation issues also need to be considered when formulating clinical practice recommendations. National Institute for Health and Care Excellence.

Machine Learning-Driven Evaluation of Pramipexole and Mood Stabilizer Combination Therapy in Bipolar Disorder

Background Bipolar disorder (BD) requires long-term management to prevent relapse of depressive episodes. The use of pramipexole, a dopamine agonist, in combination with mood stabilizers has been explored for its potential to prevent antidepressant relapse. Objective This case series aims to evaluate the efficacy and safety of pramipexole in combination with mood stabilizers in preventing antidepressant relapse in patients with bipolar disorder. Methods Two patients with bipolar disorder who were at high risk of relapse after discontinuation of antidepressants were treated with pramipexole in combination with mood stabilizers. Clinical assessments were conducted using the Mood Disorder Questionnaire (MDQ), Clinical Global Impression-Severity (CGI-S), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning (GAF) before and after the addition of pramipexole. Results The combination therapy of pramipexole and mood stabilizers effectively prevented relapse in both patients. MDQ scores decreased, CGI-S scores improved, HDRS scores reduced, and GAF scores increased, with no significant adverse effects reported over a follow-up period of 12 months. Conclusion Pramipexole in combination with mood stabilizers appears to be an effective and safe strategy for preventing antidepressant relapse in patients with bipolar disorder. These findings suggest that this combination therapy could be considered for patients at high risk of relapse after antidepressant discontinuation.

Psychodynamics of depression

This report with generalized psychodynamic processes in the psychoanalysis of patients with depression may be in demand from a practical point of view for novice psychoanalysts. The paper highlights such phenomena as resistance, negative therapeutic reaction, stages of therapy, causes of depression. The study was conducted in the paradigm of clinical psychoanalysis, the data were obtained empirically, and a clinical case was presented with the justification of interventions. It must be recognized that despite the difference in etiopathogenesis and the course of therapy, it is possible to make up a general dynamic structure of psychoanalysis of patients with depressive episodes labeled in medicine F32 – F33.9 and supplemented with anxiety-phobic disorders F40 – F41.9.