Management Of Depressive Disorder Research Articles

Adverse Childhood Experiences and Cognitive Change in late-Life Depression

ObjectivesTo determine the relationship of adverse childhood experiences (ACEs) with change in cognitive performance over a 1-year period among older adults in treatment for depression. MethodsOlder depressed adults completed the ACEs questionnaire and the Consortium to Establish a Registry of Alzheimer's disease (CERAD) cognitive battery at baseline and were re-assessed with the CERAD 1 year later. ResultsChildhood physical abuse, sexual abuse, and verbal/emotional abuse, respectively, were reported by 25%, 17.5%, and 42% of participants. Total ACEs score was not associated with baseline cognitive performance or 1-year change. However, sexual abuse, physical abuse, and a measure of cumulative verbal/emotional, physical, and sexual abuse were inversely associated with 1-year change in total CERAD score. ConclusionsChildhood abuse may have long-term adverse effects, including placing depressed older adults at risk for progressive cognitive decline. ACEs should be considered in research and clinical management of depression in older adults.

Omega-3 Polyunsaturated Fatty Acids in Depression.

Omega-3 polyunsaturated fatty acids have received considerable attention in the field of mental health, in particular regarding the treatment of depression. This review presents an overview of current research on the role of omega-3 fatty acids in the prevention and treatment of depressive disorders. The existing body of evidence demonstrates that omega-3 fatty acids, in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have antidepressant effects that can be attributed to their modulation of neuroinflammation, neurotransmitter function, and neuroplasticity. Nevertheless, clinical trials of omega-3 supplementation have yielded inconsistent results. Some studies have demonstrated significant reductions in depressive symptoms following omega-3 treatment, whereas others have shown minimal to no beneficial impact. A range of factors, encompassing dosage, the ratio of EPA to DHA, and baseline nutritional status, have been identified as having a potential impact on the noted results. Furthermore, it has been suggested that omega-3 fatty acids may act as an adjunctive treatment for those undergoing antidepressant treatment. Notwithstanding these encouraging findings, discrepancies in study designs and variability in individual responses underscore the necessity of further research in order to establish uniform, standardized guidelines for the use of omega-3 fatty acids in the management of depressive disorders.

Harnessing Data Analytics for Enhanced Understanding and Management of Depression Disorders in Mental Health Care

Depression is a widespread and incapacitating mental health condition that affects millions of people around the world.The integration of data analytics into mental health care presents a transformative opportunity to enhance the understanding, diagnosis, and management of depression. This paper explores the application of data analytics in identifying patterns and trends from diverse data sources such as electronic health records (EHRs) and social media. Through advanced techniques including machine learning, natural language processing (NLP), and predictive modeling, data analytics facilitates early detection of depressive symptoms, the development of personalized treatment plans, and continuous patient monitoring. Additionally, the aggregation and analysis of large- scale data provide valuable insights for public health strategies aimed at reducing the prevalence and impact of depression. This paper highlights the critical role of interdisciplinary collaboration in leveraging data analytics to improve mental health outcomes and underscores the importance of robust safeguards to ensure patient confidentiality and trust. Keywords Data Analytics, Depression, Mental Health, Predictive Modeling, Machine Learning, Natural Language Processing, Electronic Health Records

Therapeutic Approaches for Treatment and Management of Depressive Disorder: A Comprehensive Review

Depression, which is associated with high levels of cognitive and functional activity, melancholy, reduced activity, difficulty understanding, failure to focus, dietary abnormalities, sleep disturbances, and emotions of feelings of sadness, suicidal thoughts, and lack of hope are symptoms of a psychoneurotic disorder. It is a common and recurring disorder with a high morbidity and death rate throughout the world. Despite advances in depression treatment, such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), there remain several unmet clinical requirements in terms of effectiveness and adverse effects. These requirements range from enhanced to decreased side effects like emesis and erectile problems in treatment-resistant patients. There are a variety of combination therapies available to meet these needs. Several combination medicines and novel strategies have been found, all of which have the potential to improve one or so more areas. The kinds of targets and methods being used are extremely diverse. Therapeutic approaches, on the one hand, provide the benefits of SSRIs while including alternative routes in an attempt to improve efficacy or reduce undesirable effects. Neurotrophins (BDNF, IGF) are more novel targets on the other end of the spectrum, based on the most recent research suggesting antidepressants enhance neurogenesis. Antidepressants act by blocking many proteins, such as neurotransmitter transporters and G-protein coupled receptor families, in the brain. Some of the computational approaches that are useful for uncovering drug action mechanisms and are important for drug development are molecular docking, molecular dynamics, and drug candidates.

Is it time to abandon the concept of treatment-resistant depression?

One of the most used, but poorly defined, terms in the management of clinical depression is that of treatment-resistant depression (TRD) (McIntyre et al., 2023). It implies that persons with major depression have received a range of appropriate psychological, medical or physical treatments (at appropriate doses and for appropriate durations) but have not experienced a significant clinical response. Intrinsically, it does not require consideration as to whether those treatments provided were relevant to their age or developmental stage, clinical phenotype, interpersonal or social context, or personal illness trajectory. These broader clinical considerations often influence initial and subsequent treatment choices.

Protocol of a prospective community-based study about the onset and course of depression in a nationally representative cohort of adults in China: the China Depression Cohort Study-I

BackgroundDepression is the second most important cause of disability worldwide. Reducing this major burden on global health requires a better understanding of the etiology, risk factors, and course of the disorder. With the goal of improving the prevention, recognition, and appropriate management of depressive disorders in China, the China Depression Cohort Study will establish a nationally representative sample of at least 85,000 adults (the China Depression Cohort Study-I) and 15,000 middle school students (the China Depression Cohort Study-II) and follow them over time to identify factors that influence the onset, characteristics, and course of depressive disorders. This protocol describes the China Depression Cohort Study-I.MethodsA multistage stratified random sampling method will be used to identify a nationally representative community-based cohort of at least 85,000 adults (i.e., ≥ 18 years of age) from 34 communities in 17 of mainland China’s 31 provincial-level administrative regions. Baseline data collection includes 1) demographic, social and clinical data, 2) diagnostic information, 3) biological samples (i.e., blood, urine, hair), 4) brain MRI scans, and 5) environmental data (e.g., community-level metrics of climate change, air pollution, and socio-economic characteristics). Baseline findings will identify participants with or without depressive disorders. Annual reassessments will monitor potential risk factors for depression and identify incident cases of depression. Cox Proportional-Hazards Regression, Network analysis, Disease trajectory modelling, and Machine learning prediction models will be used to analyze the collected data. The study’s main outcomes are the occurrence of depressive disorders; secondary outcomes include adverse behaviors (e.g., self-harm, suicide), the recurrence of depression and the incidence other mental disorders.DiscussionThe China Depression Cohort Study-I will collect a comprehensive, nationally representative set of individual-level and community-level variables over time. The findings will reframe the understanding of depression from a ‘biology-psychology-society’ perspective. This perspective will improve psychiatrists’ understanding of depression and, thus, promote the development of more effective subgroup-specific antidepressant drugs and other interventions based on the new biomarkers and relationships identified in the study.Trail registrationThe protocol has been registered on the Chinese Clinical Trial Registry (No. ChiCTR2200059016).

Challenges in the management of depressive disorders comorbid with tuberculosis and type 2 diabetes.

The aim of this study was to address the most relevant diagnostic and therapeutic challenges in the management of depressive disorders among patients with diabetes mellitus and tuberculosis (TB). Depressive disorder, diabetes mellitus and TB are considered important contributors to the global burden of diseases with an emphasis on developing countries. Depressive disorder increases the chance of negative outcomes during the treatment of both diabetes mellitus and TB, while biological and adaptive changes due to diabetes mellitus and TB increase in turn the chance of depressive disorder. In this review, we present major challenges in the management of depressive disorder among patients with TB and diabetes mellitus, from detection and clinical diagnosis using appropriate diagnostic tools, to selecting the best psychotherapeutic and/or pharmacological intervention, considering the potential, adverse events and interactions due to potential polypharmacy.

Raspberry ketone: an emerging molecule for treating depression and associated symptoms - molecular docking and pharmacokinetics studies

After analyzing multiple pharmaceutical databases like ScienceDirect, PubMed, Google Scholar, and others, it was discovered that RK has yet to be linked to any anti-depressant action. The primary goal of this work was to use in-silico techniques to investigate the anti-depressant capability of RK against three major targets (monoamine oxidases, MAOs; human serotonin transporter, SERT; and serotonin receptors, 5HTs). Moreover, prediction of drug-likeliness, bioavailability, and pharmacokinetics of RK has been done using online computational tools (SwissADME, SwissTargetPrediction, and SwissBioisostere). Thein silico study indicated the emerging role of RK in the management of clinical depression. The pharmacokinetic studies, target prediction studies against 3 species, and biosisosteric-based studies also supported the possibilities of lead development. The study will open new avenues of application of this low-molecular-weight-ligand (LMWL) for the clinicians, chemists, and other scientific professionals in context to emerging depression challenges.

The intersection of astrocytes and the endocannabinoid system in the lateral habenula: on the fast-track to novel rapid-acting antidepressants.

Despite attaining significant advances toward better management of depressive disorders, we are still facing several setbacks. Developing rapid-acting antidepressants with sustained effects is an aspiration that requires thinking anew to explore possible novel targets. Recently, the lateral habenula (LHb), the brain's "anti-reward system", has been shown to go awry in depression in terms of various molecular and electrophysiological signatures. Some of the presumed contributors to such observed aberrations are astrocytes. These star-shaped cells of the brain can alter the firing pattern of the LHb, which keeps the activity of the midbrain's aminergic centers under tight control. Astrocytes are also integral parts of the tripartite synapses, and can therefore modulate synaptic plasticity and leave long-lasting changes in the brain. On the other hand, it was discovered that astrocytes express cannabinoid type 1 receptors (CB1R), which can also take part in long-term plasticity. Herein, we recount how the LHb of a depressed brain deviates from the "normal" one from a molecular perspective. We then try to touch upon the alterations of the endocannabinoid system in the LHb, and cast the idea that modulation of astroglial CB1R may help regulate habenular neuronal activity and synaptogenesis, thereby acting as a new pharmacological tool for regulation of mood and amelioration of depressive symptoms.

Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression: a qualitative study of primary care physicians and nurses

BackgroundPrimary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement.MethodsOne year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts.ResultsThe results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation.ConclusionsThe INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation.Trial registrationClinicalTrials.gov identifier: NCT03285659; Registered 18th September, 2017.

The development and validation of a prognostic model to PREDICT Relapse of depression in adult patients in primary care: protocol for the PREDICTR study

BackgroundMost patients who present with depression are treated in primary care by general practitioners (GPs). Relapse of depression is common (at least 50% of patients treated for depression will relapse after a single episode) and leads to considerable morbidity and decreased quality of life for patients. The majority of patients will relapse within 6 months, and those with a history of relapse are more likely to relapse in the future than those with no such history. GPs see a largely undifferentiated case-mix of patients, and once patients with depression reach remission, there is limited guidance to help GPs stratify patients according to risk of relapse. We aim to develop a prognostic model to predict an individual’s risk of relapse within 6–8 months of entering remission. The long-term objective is to inform the clinical management of depression after the acute phase.MethodsWe will develop a prognostic model using secondary analysis of individual participant data drawn from seven RCTs and one longitudinal cohort study in primary or community care settings. We will use logistic regression to predict the outcome of relapse of depression within 6–8 months. We plan to include the following established relapse predictors in the model: residual depressive symptoms, number of previous depressive episodes, co-morbid anxiety and severity of index episode. We will use a “full model” development approach, including all available predictors. Performance statistics (optimism-adjusted C-statistic, calibration-in-the-large, calibration slope) and calibration plots (with smoothed calibration curves) will be calculated. Generalisability of predictive performance will be assessed through internal-external cross-validation. Clinical utility will be explored through net benefit analysis.DiscussionWe will derive a statistical model to predict relapse of depression in remitted depressed patients in primary care. Assuming the model has sufficient predictive performance, we outline the next steps including independent external validation and further assessment of clinical utility and impact.Study registrationClinicalTrials.gov ID: NCT04666662

The Role of Folate-supplementation in Depression: A Narrative Review

Background: There is a relationship between the etiology and management of clinical depression and vitamin deficiencies. Aim: To review the effect of dietary folic acid supplementation on cause, severity and treatment of depression. Methods: A narrative review of empirical and theoretical literature on the effect of folic acid supplementation on the se-verity and treatment outcomes of depression. Result: Many enzymes and neurotransmitters depend on folic acid for optimal functions. The monoamine hypothesis of depression confirms the depletion of serotonin, dopamine, and norepinephrine. The systemic level of methyl folate is dependent upon the enzyme methylenetetrahydrofolate reductase [MTHFR], which is encoded by a polymorphic gene [C677T-MTHFR], as well as being dependent on dietary folic acid intake. However, folate has procarcinogenic properties because its coenzymes are involved in de novo purine and thymine nucleotide biosynthesis. Besides, folate deficiency in normal tissues may also predispose to neoplastic transformation, while folate supplementation may suppress the development of tumors in normal tissues. Epidemiological studies revealed that low folate status is associated with depression; especially in terms of severity and the outcome of antidepressant use. Conclusion: The role of folic acid in the etiology and the management of depression cannot be overemphasized. Folate supplementation has been yielding positive results in the management of depression.

Diet and depressive disorders

ABSTRACT Background: The importance of foods or food constituents in mental health is increasingly recognized, and “nutritional psychiatry” is a growing discipline. Objective: This narrative review aims to present work supporting associations between food or food constituents and mental health, specifically depressive disorders. Methods: The data presented is derived from preclinical and clinical work, including in vitro and in vivo assays, as well as observational studies and randomized clinical trials of dietary interventions. The focus of the review is the mediation of inflammatory processes and oxidative stress by dietary constituents that are an integral part of a healthy diet, such as the Mediterranean diet and similar. Results and Discussion: We present evidence for the role of the diet in prevention and management of depressive disorders, beyond the effect of individual nutrients. The findings indicate that among the dietary components with higher degree of evidence to influence depressive disorders are long chain n-3 polyunsaturated fatty acids (EPA and DHA), and various dietary bioactive compounds, especially plant-derived secondary metabolites represented by polyphenols such as flavonoids and resveratrol. Conclusion: Diet exerts an important role on mental health, and evidence indicates that some dietary constituents contribute to the prevention of depressive disorders.

Potential biomarkers of emotional stress induced neurodegeneration.

Mental health is a matter of great significance and interest both socially and scientifically. The present review aims to provide an informative platform about the classical biomarkers available to identify and diagnose the neurodegeneration induced by emotional stress and depression. Present article provides an expert comprehensive overview of the universally accepted markers and their mechanism of action involved in emotional stress assessment and its management. This envisioned piece of work emphasize on the incorporation of clinical markers in classical psychiatry experiments will make the information more significant, reliable and universally accepted. The information summaries in the article will facilitates the researchers of clinical psychiatry, neuropharmacology and neuropsychiatry in management of depressive disorders along with the identification of possible neurodegenerative association.

Kétamine, psilocybine, et antidépresseurs d'action rapide : de nouvelles promesses pour la psychiatrie?

The hypothesis of monoaminergic deficiency has long dominated the conceptual framework for the development of new antidepressant strategies, but the limits of conventional antidepressant treatments targeting monoaminergic signaling have motivated the search for new antidepressant pathways. The success of ketamine in the management of depressive disorders has provoked a renewed interest in hallucinogenic substances such as psilocybin targeting the serotonergic signaling 5HT2A and neurosteroid allosteric modulator of γ-aminobutyric acid (GABAA) receptors such as brexanolone. Unlike conventional treatments, these modulators of glutamatergic, serotonergic and GABAergic systems exert a rapid antidepressant effect ranging from 24hours to a week. Apart from their clinical interest and the fantasized search for a “miracle” molecule that jointly meets the expectations of patients and clinicians, these new targets could lead to the identification of potential new biomarkers for the development of rapid-acting antidepressants and redefine therapeutic strategies in mood disorders.

A New Paradigm for Achieving a Rapid Antidepressant Response.

The substantive delay (often 4-6weeks) between the commencement of an antidepressant and any discernible improvement in depressive symptoms is an ongoing concern in the management of depressive disorders. This delay incurs the risk of cessation of medication, self-harm/suicide and ongoing 'damage' to the brain caused by the illness. Both historically and now, off-label polypharmacy has been used in clinical practice in an attempt to facilitate both immediate- and long-term relief from symptoms. While somewhat effective, this strategy was unregulated and associated with severe adverse side effects for patients. In this article we proffer an alternative paradigm to achieve a more rapid antidepressant response by conceptualising the gap in terms of windows of response. The Windows of Antidepressant Response Paradigm (WARP) frames treatment response as windows of time in which a clinical response can be expected following initiation of an antidepressant. The paradigm defines three distinct windows-the immediate-response window (1-2days), fast-response window (up to 1 week) and slow-response window (from 1 week onwards). Newer agents such as rapid-acting antidepressants are considered to act within the immediate-response window, whereas atypical antipsychotic augmentation strategies are captured within the fast-response window. The slow-response window represents the delay experienced with conventional antidepressant monotherapy. Novel agents such as esketamine and brexpiprazole are discussed as examples to better understand the clinical utility of WARP. This framework can be used to guide research in this field and aide the development of newer, more effective antidepressant agents as well as providing a strategy to guide the prescription of multiple agents in clinical practice.

Depressive Disorders in HIV/AIDS: A Clinically Focused Narrative Review.

After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.

Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management.

Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed.

Indicators of Prognosis Independent of Treatment for Adults with Depression in Primary Care, Going Beyond Baseline Symptom-Severity: A Systematic Review and Individual Patient Data Meta-Analysis

Background: There is evidence that depressive symptom severity is associated with prognosis but existing studies have usually been for people on a single treatment so we lack evidence for this effect independent of treatment. There are other factors that we will call ‘disorder severity’ such as duration and comorbidity that have been reported as associated with prognosis, but current evidence does not indicate if these associations are independent of treatment and symptom severity. Methods: Medline, Embase, PsycINFO and Cochrane Central were searched from inception to 20th March 2019 for randomised controlled trials (RCTs) of adults seeking treatment for depression from their general practitioners, that used the Revised Clinical Interview Schedule (CIS-R) so that there was uniformity in the measurement of disorder severity factors. Individual participant data were gathered from 12 RCTs. Two-stage random-effects meta-analyses were undertaken calculating effect estimates within each study and then pooling across these to ascertain the independent association between each potential prognostic factor and depressive symptoms at 3-4 months post-baseline, remission and depressive symptoms at 6-8 months post-baseline. Risk of bias was calculated using QUIPS and quality was assessed using GRADE. Findings: Baseline depressive symptom severity was strongly associated with prognosis independent of treatment; there was a 27∙5%(95%CI: 25∙0 to 30∙1) difference in depressive symptoms at 3-4 months per one standard deviation increase in baseline score, equivalent to about eight Beck Depression Inventory points or five PHQ-9 points. The duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment were also associated with prognosis independent of depressive symptom severity, though the association with antidepressant treatment was less robust. For participants with all four of these factors, there was a difference of 39∙9%(95%CI: 12∙6 to 74∙0) in their score at 3-4 months. Risk of bias was low in all studies, quality was high and heterogeneity was within acceptable limits for all but two prognostic indicators. A number of sensitivity analyses did not alter our conclusions. Interpretation: Depressive symptom severity had a strong association with prognosis independent of treatment. The duration of depressive symptoms, duration of anxiety symptoms, panic disorder and past antidepressant use were all associated with prognosis independent of depressive symptom severity and treatment. Consideration of these prognostic indicators could be clinically important for determining prognosis and inform patients and clinicians about likely outcomes in the clinical management of depression. Funding Statement: This work was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (Programme for IW: MC_UU_12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, KC, PB, and SP), University College London (GA, GL), University of Pennsylvania (RDR), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW), and University of York (SG). Declaration of Interests: All authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: PROSPERO registration: CRD42019129512.

Evaluation of Homoeopathic Treatment Approach in Depressive Disorders of Hyderabad Urban Population of Age Group 15–30 Years: A Prospective, Non-comparative, Open-Label Observational Study

Abstract Objective Depressive disorders have an overall prevalence of 12.1%, which is clinically very significant. This study is taken up to understand the concept of the causes of depressive disorders, to understand the miasmatic state of depressive disorders and to determine the efficacy of homoeopathic medicines in the management of depressive disorders. Methods A prospective, non-comparative, open-label observational study was done at Multi-Specialty Clinic and Research Centre of The Andhra Pradesh Homoeopathic Association from 2009 to 2012. Patients aged between 15 and 30 years, presenting with symptoms of depressive disorders, were screened for inclusion and exclusion criteria and a total of 207 cases were enrolled for the study. The characteristic symptoms of the patients were recorded, repertorised, miasmatic diagnosis done and medicines prescribed based on individualisation of patient, with the help of materia medica. Hamilton depression rating scale (HAM-D) was used to assess the treatment. The parameter of improvement was - Marked improvement - 75% and above; outcome. Moderate improvement - 50% and above; Mild improvement - 25%. Results Out of 207 enrolled patients, 32 cases were dropout, while total 175 cases were analysed. The significant difference (p = 0.0001, p < 0.05) in the mean scores of HAM-D using paired t-test was observed at the end of the study; marked improvement was seen in 39 cases; moderate improvement was seen in 76; mild improvement was seen in 34 cases; no improvement was seen in 26 cases. Remedies such as Ignatia, Nat mur, Nux vomica, Staphysagria, Arsenicum album and Lycopodium were found to have a positive role. Conclusion The study showed positive and encouraging results of homoeopathic intervention in the management of patients suffering from depressive disorders as measured by HAM-D scale.