Pharmacological Management Of Depression Research Articles

Immediate effect of Bhastrika Pranayama on cerebral hemodynamics in patient with depression: A case report

BackgroundDepression is a common mental disorder with increasing prevalence in India, which involves cognitive impairment as well. Pharmacological management of depression has many adverse effects, which provides symptomatic relief to the patients, with little to no improvement in cognitive impairment or cerebral hemodynamics. This necessitates the exploration of complementary and alternative treatment modalities. Yoga, in particular Bhastrika pranyama, has been utilized as a complementary practice for various conditions, but evidence of its impact on depression and cerebral hemodynamics is limited. Case detailsA 66-year-old male, previously diagnosed with depression, was admitted to our inpatient hospital for a holistic approach to his condition, combining yoga and naturopathy as part of his treatment. During his stay, he participated in a ten-minute Bhastrika pranayama intervention, conducted under supervision. To evaluate cerebral hemodynamics, a 16-channel functional near-infrared spectroscopy (fNIRS) device was used and changes in oxygenated hemoglobin (oxyHb), deoxygenated hemoglobin (deoxyHb), and total hemoglobin (Total Hb) was recorded. ResultsFollowing the practice of Bhastrika Pranayama, the results indicated a rise in bilateral oxygenated hemoglobin (OxyHb) levels during and immediately after the practice, particularly in the prefrontal cortex region. Simultaneously, a decrease in deoxygenated hemoglobin (DeoxyHb) was observed during the practice, with a slight subsequent increase after the Bhastrika Pranayama session. ConclusionThese preliminary findings indicate that Bhastrika pranayama may have an immediate positive impact on cerebral hemodynamics in patients with depression. Further research with larger sample sizes and controlled studies is needed to confirm and generalize these observations.

The pharmacological management of depression

The pharmacological management of depression

Implementing Measurement-Based Care for Depression: Practical Solutions for Psychiatrists and Primary Care Physicians.

Measurement-based care (MBC) can be defined as the clinical practice in which care providers collect patient data through validated outcome scales and use the results to guide their decision-making processes. Despite growing evidence supporting the effectiveness of MBC for depression and other mental health conditions, many physicians and mental health clinicians have yet to adopt MBC practice. In part, this is due to individual and organizational barriers to implementing MBC in busy clinical settings. In this paper, we briefly review the evidence for the efficacy of MBC focusing on pharmacological management of depression and provide example clinical scenarios to illustrate its potential clinical utility in psychiatric settings. We discuss the barriers and challenges for MBC adoption and then address these by suggesting simple solutions to implement MBC for depression care, including recommended outcome scales, monitoring tools, and technology solutions such as cloud-based MBC services and mobile health apps for mood tracking. The availability of MBC tools, ranging from paper-pencil questionnaires to mobile health technology, can allow psychiatrists and clinicians in all types of practice settings to easily incorporate MBC into their practices and improve outcomes for their patients with depression.

Pharmacological management of depression: Japanese expert consensus

BackgroundClinically relevant issues in the real-world treatment of depression have not always been captured by conventional treatment guidelines. MethodsCertified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology were asked to evaluate treatment options regarding 23 clinical situations in the treatment of depression using a 9-point Likert scale (1=“disagree” and 9=“agree”). According to the responses of 114 experts, the options were categorized into first-, second-, and third-line treatments. ResultsFirst-line antidepressants varied depending on predominant symptoms: escitalopram (mean ± standard deviation score, 7.8 ± 1.7) and sertraline (7.3 ± 1.7) were likely selected for anxiety; duloxetine (7.6 ± 1.9) and venlafaxine (7.2 ± 2.1) for loss of interest; mirtazapine for insomnia (8.2 ± 1.6), loss of appetite (7.9 ± 1.9), agitation and severe irritation (7.4 ± 2.0), and suicidal ideation (7.5 ± 1.9). While first-line treatment was switched to either an SNRI (7.7 ± 1.9) or mirtazapine (7.4 ± 2.0) in the case of non-response to an SSRI, switching to mirtazapine (7.1 ± 2.2) was recommended in the case of non-response to an SNRI, and vice versa (switching to an SNRI (7.0 ± 2.0) in the case of non-response to mirtazapine). Augmentation with aripiprazole was considered the first-line treatment for partial response to an SSRI (7.1 ± 2.3) or SNRI (7.0 ± 2.5). LimitationsThe evidence level of expert consensus is considered low. All included experts were Japanese. ConclusionsRecommendations made by experts in the field are useful and can supplement guidelines and informed decision making in real-world clinical practice. We suggest that pharmacological strategies for depression be flexible and that each patient's situational needs as well as the pharmacotherapeutic profile of medications be considered.

The Shared Decision-Making Process in the Pharmacological Management of Depression

Shared decision making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. There is an international consensus across medicine about the importance of SDM interventions, which have raised great interest in mental healthcare over the last decade. Yet SDM is not widely adopted, particularly in the field of psychiatry. The purpose of the present article is to examine, from a patient and physician perspective, the importance of SDM in the management of healthcare with a focus on mental health; it reviews the enablers and barriers (and how to overcome them) to implementing a SDM process in psychiatric practice. SDM models have been developed recently for involving patients with depression in the decision-making process, which could result in augmenting the proportion of patients who adhere to their antidepressant or other treatments for a duration that complies with the current recommendations. To implement this approach, more physicians need training in the SDM approach and access to appropriate tools that help engage in collaborative deliberation, and practice generally needs to be reorganized around the principles of patient engagement.

Bullying Linked to Depression in Youth With Autism

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessBullying Linked to Depression in Youth With AutismRebecca GreenbergRebecca GreenbergSearch for more papers by this authorPublished Online:16 Aug 2018https://doi.org/10.1176/appi.pn.2018.8a8AbstractChildren with autism are often the target of bullying, which can contribute to the development of depression.By age 10, children with autism spectrum disorder (ASD) or autistic traits have more symptoms of depression than their peers, according to a study published June 13 in JAMA Psychiatry. Irrespective of genetic factors, the researchers found that depressive symptoms worsened up to the end of the study as the adolescents reached age 18 and were exacerbated by bullying. “[F]urther research into the role of traumatic experiences, such as bullying, and the utility of interventions to reduce bullying or address its adverse effects could have the potential to reduce the burden of depression in this population,” wrote lead author Dheeraj Rai, Ph.D., a senior lecturer in psychiatry at the University of Bristol, and colleagues. For the study, the authors relied on data from the Avon Longitudinal Study of Parents and Children. The Avon study collected data from 1990 to 1992 on more than 15,000 parents and children from pregnancy through childhood in the Bristol area from self-report questionnaires; clinical assessments; biological samples; and birth, medical, and educational records.The final dataset for the study included 8,087 children. Five groups were identified as either having ASD or symptoms of ASD. Of this group, 96 were diagnosed with ASD, 546 had social communication impairments, 526 had problems with speech coherence, 419 displayed repetitive behaviors, and 801 had poor social temperament with overlap between the groups. Participants with ASD and the four autistic traits had higher depression scores than the general population, as assessed by the Short Mood and Feelings Questionnaire (SMFQ) and the computerized version of the Clinical Interview-Revised, a psychiatric interview widely used in community samples. Their scores continued to rise over time. The SMFQ was administered at six points between ages 10 and 18 via mailed questionnaires or in clinics. Data analysis was conducted from January to November 2017.At age 10, the children with ASD or autistic traits who reported being bullied had the highest average SMFQ scores; likewise, youth with social communication impairments who reported being bullied in childhood or adolescence were more likely to have a diagnosis of depression at age 18.“It is possible that children with social communication problems, who may not have developed a good understanding of social rules and how to fit in, may be targets for bullies,” Rai told Psychiatric News. “Many of the autistic people I have worked with over the years have mentioned that the awareness of being excluded or targeted because of being perceived as different was particularly traumatic.” “These findings add to the evidence highlighting a higher burden of depression and also suggest a potentially modifiable pathway, through bullying,” the authors wrote. “However, gaps remain in our understanding of the measurement and phenomenology of depression in individuals with autism, which could be a priority for future research. Further work could also focus on improvements in psychological and pharmacological management of depression in ASD.”A systematic review of nearly 8,000 research articles in the March issue of the Journal of Abnormal Child Psychology reported that people with ASD are four times more likely to experience depression in their lifetime than people without ASD.Rai noted that depression can be more difficult to detect in these patients because they may not recognize or be able to describe their mood states. For clinicians, Rai said the study shows that many young people and adults with depression have also had a history of trauma. “[T]hese findings suggest that focusing on the role of traumatic experiences such as bullying and interventions targeting these could be important and may have the potential to make a real difference in the well-being of autistic people,” he said in a press release from the University of Bristol. The study was funded by the Baily Thomas Charitable Fund. ■“Association of Autistic Traits With Depression From Childhood to Age 18 Years” can be accessed here. “Prevalence of Depressive Disorders in Individuals With Autism Spectrum Disorder: a Meta-Analysis” is available here. ISSUES NewArchived

A P2X7 receptor antagonist reverses behavioural alterations, microglial activation and neuroendocrine dysregulation in an unpredictable chronic mild stress (UCMS) model of depression in mice

A polymorphism in the P2RX7 gene that encodes for the P2X7 ionotropic ATP-gated receptor (P2X7R) protein has been shown to be associated with an increased risk for developing depressive illnesses. However, the role of P2X7R in depression is still unclear. To better understand the role of P2X7R and its subsequent impact on microglial activation, we compared the effect of the P2X7R antagonist Brilliant Blue G (BBG) with that of fluoxetine in an unpredictable chronic mild stress (UCMS) model of depression in mice. Our results indicate that BBG (50 mg/kg body weight in 0.9% NaCl, 10 ml/kg/day) successfully reversed the degradation of coat states and nest-building scores induced by exposure to UCMS, similar to the conventional antidepressant fluoxetine (15 mg/kg body weight in 0.9% NaCl, 10 ml/kg/day). BBG also reversed the UCMS-induced microglial activation in cortical and hippocampal regions and the basal nuclei of mouse brains and corrected the UCMS-induced hypothalamo-pituitary-adrenal (HPA) axis dysregulation. In contrast to fluoxetine, however, BBG treatment did not increase the density of doublecortin-positive cells in the dentate gyrus, indicating that BBG had no impact on hippocampal neurogenesis. These results suggest that P2X7R is involved in recovery from depressive-like states caused by exposure to UCMS in a mechanism that involves restoration of the HPA axis but not hippocampal neurogenesis. These results add to the evidence that P2X7R antagonist agents may have potential value in the pharmacological management of depression.

The pharmacological management of depression – Update 2017

Depression affects nearly 350 million people worldwide. Local data indicates that approximately 17% of all South Africans will experience at least one episode of depression in their lifetime. Depressive disorders contribute significantly towards overall morbidity and increased risk for suicide. Antidepressant therapy remains one of the cornerstones in the management of depressive disorders. Although the efficacy of antidepressive drugs is continuously subjected to criticism, thousands of controlled clinical trials have shown, and will continue to show, their benefit in the effective treatment of depressive disorders. Since the introduction of antidepressants in the early 1950s, researchers have been searching for an ideal antidepressant able to adequately reduce, preserve and prevent features of depression with the absence of side effects. This article summarizes the currently available antidepressant drugs in South Africa. Discontinued products have been omitted and newly registered agents have been added. This review does not contain reference to any experimental drug, or substances not yet available for local use.

Pharmacologic Management of Depression in Advanced Illness #309.

Journal of Palliative MedicineVol. 19, No. 7 Fast Facts and ConceptsPharmacologic Management of Depression in Advanced Illness #309Leah Rosenberg and Jane deLima ThomasLeah RosenbergSearch for more papers by this author and Jane deLima ThomasSearch for more papers by this authorPublished Online:23 Jun 2016https://doi.org/10.1089/jpm.2016.0075AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Pharmacologic Management of Depression in Advanced Illness #309." Journal of Palliative Medicine, 19(7), pp. 783–784FiguresReferencesRelatedDetailsCited byZentrales NervensystemZentrales Nervensystem Volume 19Issue 7Jul 2016 InformationCopyright 2016, Mary Ann Liebert, Inc.To cite this article:Leah Rosenberg and Jane deLima Thomas.Pharmacologic Management of Depression in Advanced Illness #309.Journal of Palliative Medicine.Jul 2016.783-784.http://doi.org/10.1089/jpm.2016.0075Published in Volume: 19 Issue 7: June 23, 2016Online Ahead of Print:June 10, 2016PDF download

7,8-Dihydroxyflavone, a Tropomyosin-Kinase Related Receptor B Agonist, Produces Fast-Onset Antidepressant-Like Effects in Rats Exposed to Chronic Mild Stress.

ObjectiveBrain-derived neurotrophic factor (BDNF) and its specific receptor, tropomyosin-related kinase (TrkB), play important roles in treating depression. In this experiment, we examined whether 7,8-dihydroxyflavone, a novel potent TrkB agonist, could reverse the behavioral and biochemical abnormalities induced by the chronic mild stress (CMS) paradigm in rats.MethodsSD rats were exposed to a battery of stressors for 56 days. 7,8-dihydroxyflavone (5 and 20 mg/kg) were administered intraperitoneally during the last 28 days of the CMS paradigm. Rats were tested in sucrose consumption test (SCT), forced-swimming test (FST) and elevated T-maze (ETM). Serum corticosterone levels and hippocampal BDNF levels of the rats were measured.ResultsFour-week CMS on the rats induced their depression-like behavior in SCT. The CMS-reduced sucrose consumption was reversed starting from 7 days after the 7,8-dihydroxyflavone (20 mg/kg) treatment and remained across the subsequent treatment regime. 7,8-dihydroxyflavone, when given at 5 mg/kg for 3 weeks, reduced the immobility time in the FST in the CMS-subjected rats. Additionally, the 4-week treatment with 7,8-dihydroxyflavone (20 mg/kg) attenuated the CMS-induced increase in anxiety-like behavior in the ETM. For the CMS-subjected rats, 7,8-dihydroxyflavone treatment dose-dependently reduced their serum corticosterone levels but increased their hippocampal BDNF levels only at 5 mg/kg.Conclusion7,8-dihydroxyflavone was beneficial for both depression and anxiety-like behaviors, and may exert fast-onset antidepressant effects. This provides a new insight into the pharmacological management of depression.

Expert Opinion-Depression in Patients with Heart Failure: Is Enough Being Done?

Depression is a major issue in heart failure (HF). Depression is present in about one in five HF patients, with about 48 % of these individuals having significant depression. There is a wide variation in reported prevalences because of differences in the cohorts studied and methodologies. There are shared pathophysiological mechanisms between HF and depression. The adverse effects of depression on the outcomes in HF include reduced quality of life, reduced healthcare use, rehospitalisation and increased mortality. Results from metaanalysis suggest a twofold increase in mortality in HF patients with compared to those without depression. Pharmacological management of depression in HF has not been shown to improve major outcomes. No demonstrable benefits over cognitive behavioural therapy and psychotherapy have been demonstrated.

Pharmacological Management of Depression in Patients with Cancer: Practical Considerations

This article provides an overview of the prevalence, pathogenesis and diagnosis of, and treatment strategies for, depression in cancer patients. Untreated depression can increase the burden of oncology symptoms and worsen the cancer prognosis through the relationship between mood and immunity. The issues to consider when treating a patient with cancer who has depression include when to introduce pharmacotherapy, the criteria for choosing an antidepressant, and the necessary caution regarding side effects and drug interactions. The choice of an antidepressant is a complex decision that has to balance previous pharmacological experiences, different clusters of target symptoms, pharmacological interactions, and objective and subjective risks of side effects, with the aim of tailoring a strategy for each patient.

Future perspectives on the pharmacological management of depression

Major depressive disorder is a disabling condition that impacts on function and well-being. It is one of the leading causes of disease burden in high-income countries. Treatment of this disorder can be challenging because a significant minority of patients do not respond to initial pharmacotherapy. There has been on-going debate about the ‘efficacy’ of antidepressants given a large placebo response in trial data. In this nonsystematic review this is discussed and recent studies are quoted that point to more effective ways in interpreting antidepressant randomized controlled trial data. An analysis of recent studies that impact on current clinical practice is also presented, including studies of Agomelatine, antidepressant combinations and augmentation strategies. Studies that may pave the way to more effective treatments and a better understanding of the pathophysiology of this disabling condition are highlighted. These include introduction of triple reuptake inhibitors, NMDA receptor antagonists and glucocorticoid receptor antagonists.

The pharmacologic management of depression in Parkinson's disease.

Depression in Parkinson's disease (PD) is common, and it appears to worsen the motor and cognitive progression of the disease, and limits the patient's quality of life. In this paper, we review the pharmacotherapy of depression in people with PD. We find that evidence is sparse when it comes to this patient population. There is some evidence that older tricyclic antidepressants (nortriptyline and desipramine) may be effective in this population. There is also growing evidence that newer antidepressants like paroxetine and venlafaxine may be effective. We will also review a number of other promising medication treatments. What is apparent is the need for more research identifying the most effective medications for treating depression in this population. We provide recommendations that fall in line with current evidence-based practice for managing depression in the general population. Also, we suggest that collaborative models of depression care may be a promising approach to support the identification and effective treatment of those with PD also suffering from depressive disorders.

Pharmacogenetics and the pharmacological management of depression

Pharmacogenetics and the pharmacological management of depression

Pharmacogenetics and the pharmacological management of depression

Depression is a chronic disease seen in many healthcare settings. Current pharmacological treatment options are successful in two-thirds of patients. One CYP450 enzyme, CYP2D6, is responsible for the metabolism of 30% of all drugs including many antidepressants. Phenotypes of metabolizer status affect antidepressant treatment outcomes and adverse drug reactions.

The influence of organisational characteristics on pharmacological management of depression in US nursing homes

Abstract Focal points

Management of depression in the last month of life

In clinical practice, assessment and adequate treatment of depression in the last month of life remain a difficult task. Although assessment instruments and criteria for depression are available for use in the palliative care population, few have been applied for the last weeks of life. The same is true for clinical management including antidepressants. Assessment aids such as Hospital Anxiety and Depression Scale or Hamilton Depression Rating Scale are available and validated for the last days or weeks of life, but its clinical impact remains unclear. The wish to die may symbolize more the acceptance that life comes to an end instead of reflecting a depressive or anxiety disorder. Communication about concrete preparation for death, life completion discussions, expressing religious struggle and giving back a sense of coherence seem to be promising non-pharmacological strategies and may lead to improved social function and better management of physical symptoms. Good news for researchers comes from a recent study highlighting the fact that psychosocial research seems to be of more potential benefit than burden for the patient. No recent literature can be found on the pharmacological management of depression in the last weeks of life. Few studies demonstrate the usefulness of concrete end of life preparation discussions that underpins the importance and impact of best carer-patient relationship during this last phase of life. A Cochrane protocol on antidepressants in severely physically ill patients has been undertaken recently to highlight this important clinical question, but results may reflect the lack of studies focusing on the last weeks or days of life.

Misinterpretation of randomized trial evidence: do antidepressants work?

On February 29 this year I was due to give a talk about the pharmacological management of depression to a large meeting of psychiatrists. As my radio alarm clock came on I heard the top headline on the BBC Radio 4 Today programme ‘New study suggests that antidepressants don't work’. The headline arose from a meta-analysis published by Irvine Kirsch, Professor of Psychology at the University of Hull, and colleagues (Kirsch et al, 2008).

Review of the Pharmacologic Management of Depression

Review of the Pharmacologic Management of Depression