Rates Of Major Depressive Disorder Research Articles

Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings

ABSTRACT This study assessed the rate of a.) the total and b.) specific psychiatric comorbidities among the three severity ratings for Anorexia Nervosa (AN): DSM-5, ICD-11 and overvaluation of weight and shape (OWS). The sample comprised 312 treatment-seeking patients with AN (mean age = 26.9). Weight and height were taken at intake to calculate BMI, the foundation for the DSM-5 and ICD-11 severity indices. The EDE-Q was used to assess OWS, and the Mini International Neuropsychiatric Interview was conducted to assess psychiatric comorbidities. For the DSM-5, the mild severity group showed a higher total number of psychiatric comorbidities, especially for panic, social anxiety, generalised anxiety, and post-traumatic stress disorders compared to the severe and extremely severe groups. ICD-11 and OWS severity groups did not significantly differ in total comorbidities, except for major depressive disorder and obsessive-compulsive disorders being more prevalent in the “significantly low BMI” ICD-11 group. The high OWS group displayed a notably higher rate of major depressive disorder than the low OWS group. The study underscores inconsistent patterns across the three severity systems, emphasising the need to recognise the current limitations of the assessed severity classification systems in AN assessment and guiding treatment.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management.

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

The differences of event-related potential components in patients with comorbid depression and anxiety, depression, or anxiety alone

BackgroundThere was a high comorbidity rate of major depressive disorder (MDD) and generalized anxiety disorder (GAD), showing a poor prognosis and significant detrimental impact on functioning. The study aimed to find whether patients with comorbid GAD and MDD had some differences in cognitive functions from patients with MDD or GAD alone. Methods360 adult patients were enrolled from inpatient department of psychiatry from 2020 to 2022. They were divided into three groups with 120 patients for each group: MDD, GAD, and MDD + GAD. All the patients completed psychological evaluation scales including patient health questionnaire-9 (PHQ-9) and 7-item generalized anxiety disorder (GAD-7). All the patients underwent examinations of auditory brainstem response and event-related potentials (ERPs). ResultsIn MDD + GAD group, P3b latency was significantly longer than patients with MDD alone, and P300 reaction time was positively correlated with total score of GAD-7 and PHQ-9, and PHQ-9 total score was also significantly positively correlated with P2-P3b amplitude (all p < 0.05). In addition, MDD patients had significantly longer P300 reaction time and lower P2-P3b amplitude than the GAD group (p < 0.05). LimitationsIt was a single-center and cross-sectional study, and we used self-report scales as assessment tools. ConclusionsPatients with MDD and GAD comorbidity might have a worse cognitive function than MDD patients, and the severity of cognitive impairments was positively correlated with the severity of anxiety and depression symptoms.

Major depressive disorder in post-secondary students attending foodbanks in France.

Poor mental health among youth is a major public health issue that has risen to the forefront since the COVID-19 crisis, especially among post-secondary students and precarious populations. The objectives of this work were to evaluate the rate of major depressive disorder (MDD) among precarious post-secondary students in the greater Paris region, to describe its risk factors, and to identify determinants for not seeking care. We conducted a multi-site, cross-sectional survey of post-secondary students attending a selection of 13 student foodbanks in the greater Paris region (France) between 30 November 2021 and 27 January 2022. This study had two complementary epidemiological and sociological components: a quantitative description of MDD through completion of a questionnaire performed through face-to-face or telephone interviews, and a qualitative assessment of the factors underlying MDD through in-depth follow-up interviews conducted among a sub-selection of students who participated in the first phase. Among 456 students who participated in our survey, 35.7% presented with MDD. The risk of suffering from MDD was higher among women, students housed by third-parties, students reporting moderately to severely hungry and/or poor physical health. Students receiving material and/or social support were less likely to present with MDD. Among students who reported needing health care in the last year or since their arrival in France, 51.4% did not seek care. To address poor mental health among precarious students, policy action must jointly consider financial precarity, administrative barriers, housing, food security, physical health, and access to health services, especially mental health.

Suicide and depression in former contact sports participants: population-based cohort study, systematic review, and meta-analysis.

Former participants in sports characterised by low intensity repetitive head impact appear to have elevated rates of later dementia, but links with other psychological health outcomes such as depression and suicide are uncertain. We quantified the occurrence of these endpoints in former contact sports athletes against general population controls using new data from a cohort study and a meta-analysis. The cohort study comprised 2004 retired male athletes, who had competed internationally as amateurs for Finland across a range of sports, and 1385 general population controls. All study members were linked to mortality and hospitalisation registries. In the PROSPERO-registered systematic review (CRD42022352780), we searched PubMed and Embase to October 31 2022 for cohort studies that reported standard estimates of association and precision. Study-specific estimates were aggregated in a random-effect meta-analysis. The Newcastle-Ottawa Scale was used to appraise the quality of each study. In survival analyses of the Finnish cohort data, former boxers (depression: hazard ratio 1.43 [95% CI 0.73, 2.78]; suicide: 1.75 [0.64, 4.38]), Olympic-style wrestlers (depression: 0.94 [0.44, 2.00]; suicide: 1.60 [0.64, 3.99]), and soccer players (depression: 0.62 [0.26, 1.48]; suicide: 0.50 [0.11, 2.16]) did not have statistically higher rates of major depressive disorder or suicide at follow-up relative to controls. In the systematic review, 7 cohort studies met inclusion criteria. After aggregating results with the Finnish cohort, retired soccer players appeared to have a lower risk of depression (summary risk ratio: 0.71 [0.54, 0.93]) relative to general population controls, while the rate of suicide was statistically the same across groups (0.70 [0.40, 1.23]). Past participation in American football seemed to be associated with some protection against suicide (0.58 [0.43, 0.80]) but there were insufficient studies of depression in this sport to facilitate aggregation. The aggregation of results from the soccer and American football studies showed directionally consistent relationships and there was no indication of inter-study heterogeneity (I2=0%). Based on a small cluster of studies exclusively comprising men, retired soccer players had a lower rate of later depression and former American football players had a lower risk of suicide relative to comparator groups. Whether these findings are generalisable to women requires testing. The preparation of this manuscript was unfunded.

Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden

The association of early diagnosis and management of bipolar disorder with adolescent suicide mortality (ASM) is unknown. To assess regional associations between ASM and bipolar disorder diagnosis frequencies. This cross-sectional study investigated the association between annual regional ASM and bipolar disorder diagnosis rates in Swedish adolescents aged 15 to 19 years in January 1, 2008, through December 31, 2021. Aggregated data without exclusions reported at the regional level encompassed 585 suicide deaths, constituting 588 unique observations (ie, 21 regions, 14 years, 2 sexes). Bipolar disorder diagnosis frequencies and lithium dispensation rates were designated as fixed-effects variables (interaction term in the case of males). An interaction term between psychiatric care affiliation rates and the proportion of psychiatric visits to inpatient and outpatient clinics constituted independent fixed-effects variables. Region and year comprised random intercept effect modifiers. Variables were population adjusted and corrected for heterogeneity in reporting standards. The main outcomes were sex-stratified, regional, and annual ASM rates in adolescents aged 15 to 19 years per 100 000 inhabitants as analyzed using generalized linear mixed-effects models. Female adolescents were diagnosed with bipolar disorder almost 3 times more often than male adolescents (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100 000 inhabitants, respectively). Median regional prevalence rates of bipolar disorder varied over the national median by a factor of 0.46 to 2.61 and 0.00 to 1.82 in females and males, respectively. Bipolar disorder diagnosis rates were inversely associated with male ASM (β = -0.00429; SE, 0.002; 95% CI, -0.0081 to -0.0004; P = .03) independent of lithium treatment and psychiatric care affiliation rates. This association was replicated by β-binomial models of a dichotomized quartile 4 ASM variable (odds ratio, 0.630; 95% CI, 0.457-0.869; P = .005), and both models were robust after adjusting for annual regional diagnosis rates of major depressive disorder and schizophrenia. No such association was observed in females. In this cross-sectional study, lower suicide death rates in adolescent males was robustly associated with regional diagnosis rates of bipolar disorder at an estimated magnitude of approximately 4.7% of the mean national suicide death rate. The associations could be due to treatment efficacy, early diagnosis and management, or other factors not accounted for.

Al Mal Tiempo, Buena Cara (keeping a good face during bad times): Differential psychosocial and health profiles between Hispanic and non-Hispanic public-school teachers in Texas

Objective This study evaluated if Hispanic public-school educators are at an increased risk for psychological distress, general health conditions, and mental health issues and disorders. Methods Using a cross-sectional, online survey, Hispanic (n = 702) and non-Hispanic (n = 2554) K-12 public school teachers participated in an occupational health study to examine differences between Hispanic and non-Hispanic teachers’ occupational factors, psychological and social factors, and physical health. Results The results showed that Hispanic teachers demonstrated lower levels of psychosocial functioning, and higher rates of major depressive disorder, somatization disorder, generalized anxiety disorder, and panic disorder. Hispanic educators reported poorer levels of physical functioning, including sleep disturbances, various body pains, skin rashes, allergies, tinnitus, vision issues, and deficits to balance and memory loss. Conclusions Hispanic educators are more likely to experience ethnic disparities complicating intersectional stressors found among an already psychologically vulnerable minoritized population. As an underserved ethnic group, it’s important for school districts to provide culturally informed mental health and general health programs that address ethnic disparities, such as cultural stress, mental illness stigmas, access to professional services, and the importance of receiving quality care.

Reducing default mode network connectivity with mindfulness-based fMRI neurofeedback: a pilot study among adolescents with affective disorder history

Adolescents experience alarmingly high rates of major depressive disorder (MDD), however, gold-standard treatments are only effective for ~50% of youth. Accordingly, there is a critical need to develop novel interventions, particularly ones that target neural mechanisms believed to potentiate depressive symptoms. Directly addressing this gap, we developed mindfulness-based fMRI neurofeedback (mbNF) for adolescents that aims to reduce default mode network (DMN) hyperconnectivity, which has been implicated in the onset and maintenance of MDD. In this proof-of-concept study, adolescents (n = 9) with a lifetime history of depression and/or anxiety were administered clinical interviews and self-report questionnaires, and each participant’s DMN and central executive network (CEN) were personalized using a resting state fMRI localizer. After the localizer scan, adolescents completed a brief mindfulness training followed by a mbNF session in the scanner wherein they were instructed to volitionally reduce DMN relative to CEN activation by practicing mindfulness meditation. Several promising findings emerged. First, mbNF successfully engaged the target brain state during neurofeedback; participants spent more time in the target state with DMN activation lower than CEN activation. Second, in each of the nine adolescents, mbNF led to significantly reduced within-DMN connectivity, which correlated with post-mbNF increases in state mindfulness. Last, a reduction of within-DMN connectivity mediated the association between better mbNF performance and increased state mindfulness. These findings demonstrate that personalized mbNF can effectively and non-invasively modulate the intrinsic networks associated with the emergence and persistence of depressive symptoms during adolescence.

Analysis of Time to Diagnosis and Outcomes Among Adults With Primary Hyperparathyroidism.

Despite access to routine laboratory evaluation, primary hyperparathyroidism (PHP) remains underdiagnosed and undertreated. To determine the consequences associated with missed diagnoses and prolonged time to diagnosis and treatment of PHP. This is a retrospective cohort study of patients older than 40 years with 2 instances of hypercalcemia during 2010 to 2020 and 3 years of follow-up. Patients were recruited from 63 health care organizations in the TriNetX Research Network. Data analysis was performed from January 2010 to September 2020. Elevated serum calcium. Existing symptoms and diagnoses associated with PHP (osteoporosis, fractures, urolithiasis, major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, constipation, insomnia, polyuria, weakness, abdominal pain, headache, nausea, amnesia, and gallstones) compared in patients deemed high-risk and without a diagnosis and matched controls, and those who experienced times from documented hypercalcemia to diagnosis and diagnosis to treatment within or beyond 1 year. There were 135 034 patients analyzed (96 554 women [72%]; 28 892 Black patients [21%] and 88 010 White patients [65%]; 3608 Hispanic patients [3%] and 98 279 non-Hispanic patients [73%]; mean [SD] age, 63 [10] years). Two groups without a documented diagnosis of PHP were identified as high risk: 20 176 patients (14.9%) with parathyroid hormone greater than or equal to 50 pg/mL and 24 905 patients (18.4%) with no parathyroid hormone level obtained or recorded explanation for hypercalcemia. High-risk patients experienced significantly increased rates of all associated symptoms and diagnoses compared with matched controls. Just 9.7% of those with hypercalcemia (13 136 patients) had a diagnosis of PHP. Compared with individuals who received a diagnosis within 1 year of hypercalcemia, those whose workup exceeded 1 year had significantly increased rates of major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, polyuria, weakness, abdominal pain, and headache at 3 years. The rate of osteoporosis increased from 17.1% (628 patients) to 25.4% (935 patients) over the study period in the group with delayed diagnosis. Among those with a diagnosis, 5280 patients (40.2%) underwent parathyroidectomy. Surgery beyond 1 year of diagnosis was associated with significantly increased rates of osteoporosis and hypertension at 3 years after diagnosis compared with those treated within 1 year. Many patients were at high risk for PHP without a documented diagnosis. Complications in these patients, as well as those who received a diagnosis after prolonged workup or time to treatment, resulted in patient harm. System-level interventions are necessary to ensure proper diagnosis and prompt treatment of PHP.

MANAGEMENT OF DEPRESSION IN OLDER ADULTS RECEIVING CARE IN MEDICAL SETTINGS

Abstract Although rates of major depressive disorder are lower among older adults, depressive symptoms are a common presentation for aging individuals in medical settings. Unique challenges arise when treating depressive symptoms co-occurring with brain health concerns in older adults with a complex medical history. This presentation reviews how cognitive behavioral interventions for later-life depression are relevant for mental health practitioners who work in primary care and general medical settings. Specific clinical and multicultural considerations will be highlighted to support clinicians and interdisciplinary teams to work effectively with older adults who have co-existing depressive symptoms and cognitive concerns.

Placebo Effect in Randomized Trials of Major Depressive Disorder With Psychotic Features: A Systematic Review and Descriptive Meta-Analysis.

In the 1980s, the response rate of major depressive disorder with psychotic features (MDD-Psy) to placebo pills was reported to be close to 0%. To our knowledge, this placebo response rate has not been systematically reassessed. We undertook a systematic review of randomized controlled trials (RCTs) that have used a placebo or sham control group for MDD-Psy. We searched MEDLINE and identified 9 relevant publications reporting on 10 studies comparing a placebo or sham interventions versus an active intervention. We extracted reported rates of response or of dropout for all causes associated with placebo versus active intervention(s) and aggregated response and dropout rates across trials. Two sham-controlled electroconvulsive therapy (ECT) trials did not provide response rates. In the 3 pharmacotherapy studies published in the 1980s, 0 of 12 participants (0%) responded to placebo versus 13 of 38 (34.2%) responding to the active interventions. In contrast, 5 RCTs published in the 2000s, 114 of 339 participants (33.6%) randomized to placebo responded versus 149 of 373 participants (39.9%) randomized to active interventions; dropout rates were 71/236 (30.1%) for placebo versus 84/282 (29.8%) for the active interventions. As expected, response rates to placebo pills in RCTs for MDD-Psy increased markedly from the 1980s to the 2000s. Methodological issues in the design and conduct of more recent RCTs may have contributed to the high placebo response. However, one needs to consider this placebo response rate when interpreting the result of recent trials of MDD-Psy, which typically have not included a "pure" placebo condition.

Post-Traumatic Stress Disorder, Major Depressive Disorder, and Wildfires: A Fifth-Year Postdisaster Evaluation among Residents of Fort McMurray.

Background: Over 90,000 residents had to be evacuated from Fort McMurray (FMM), Alberta, Canada due to the wildfire that engulfed the city in May 2016. Overall, about 2400 homes or 10% of the housing stock in Fort McMurray were destroyed. The fire consumed about 200,000 hectors of forest, reaching into Saskatchewan. During major disasters, communities’ infrastructure is disrupted, and psychological, economic, and environmental effects are felt for years afterwards. Objective: Five years after the wildfire disaster, this study assessed the prevalence rate of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) in Fort McMurray residents and determined the demographic, clinical, and other risk factors of probable MDD and PTSD. Methodology: A quantitative cross-sectional survey was conducted to collect data through an online questionnaire administered via REDCap between 24 April and 2 June 2021. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of MDD symptoms in respondents. The PTSD Checklist for DSM-5 (PCL-C) was used to assess likely PTSD in respondents. Descriptive, univariate, and multivariate regression analyses were employed. Results: 186 out of 249 individuals who accessed the survey link completed it (74.7% response rate). The median age of the subscribers was 42. The sample included a majority of 159 (85.5%) females; 98 (52.7%) > 40 years of age; 175 (94.1%) employed; and 132 (71%) in a relationship. The overall prevalence of MDD symptoms in our study sample was 45.0% (76). Four variables independently predicted MDD symptoms in the multivariate logistic regression model, including: unemployed (OR = 12.39; 95% CI: 1.21–126.37), have received a mental diagnosis of MDD (OR = 4.50; 95% CI: 1.57−12.92), taking sedative-hypnotics (OR = 5.27; 95% CI: 1.01−27.39), and willingness to receive mental health counseling (OR = 4.90; 95% CI: 1.95–12.31). The prevalence of likely PTSD among our respondents was 39.6% (65). Three independent variables: received a mental health depression diagnosis from a health professional (OR = 4.49; 95% CI: 1.40–14.44), would like to receive mental health counseling (OR = 4.36, 95% CI: 1.54–12.34), and have only limited or no support from family (OR = 11.01, 95% CI: 1.92–63.20) contributed significantly to the model for predicting likely PTSD among respondents while controlling the other factors in the regression model. Conclusions: According to this study, unemployment, taking sleeping pills, having a prior depression diagnosis, and the willingness to receive mental health counseling significantly increase the odds of having MDD and PTSD following wildfires. Family support may protect against the development of these conditions.

How Far Has Repetitive Transcranial Magnetic Stimulation Come Along in Treating Patients With Treatment-Resistant Depression?

Antidepressant drugs have been the mainstay for treating patients with major depressive disorder. However, with a rapid rise in the rates of major depressive disorder, there has been a substantial increase in the resistance to antidepressants in the last decade. This has augmented the need for alternative treatment modalities, including repetitive transcranial magnetic stimulation. This review assesses the progress repetitive transcranial magnetic stimulation has made in treating patients resistant to antidepressants. We conducted a comprehensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The clinical studies reviewed under the scope of this paper showed significant benefits in treatment-resistant patients. Several studies demonstrated that the prefrontal cortex's unilateral and bilateral transcranial magnetic stimulation increased the remission rates in active treatment groups compared to the control. Treatments ranged from 10 to 20 sessions, with 1,600 pulses to a maximum of 4,000 pulses in unilateral stimulation and 720 to 2,100 pulses in bilateral stimulation per session. Interestingly, bilateral stimulation utilizing fewer pulses showed notable improvement than a higher number of pulses in unilateral stimulation. However, the lack of standardized dose, dosing frequency, treatment duration, and follow-up protocols warrant further research to bring this therapy into clinical practice.

Influences of Aging on PTSD Prevalence, Neurobiology, and Clinical Course

Posttraumatic stress disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Recent studies report increasing prevalence rates of PTSD among older adults, and this pattern is anticipated to accelerate as the population skews older and Veterans from recent conflicts age. Most older adults suffer from chronic PTSD, which is associated with at least one disability in nearly 80% of cases. Compared to those without PTSD, individuals with chronic PTSD have exceedingly high rates of Major Depressive Disorder (MDD), triple the rates of drug abuse, and significant functional impairment. Prompt diagnosis and treatment of PTSD in later life is complicated by its differing phenomenology in older compared to younger adults and age-related changes in treatment seeking. Whereas overall symptom severity, intrusive thoughts, and avoidance behaviors are lower among older adults with PTSD, they more frequently report somatic problems (e.g., pain, insomnia, gastrointestinal upset) relative to emotional issues (e.g., specific aspects of the trauma). Older patients may not spontaneously report traumatic experiences or minimize their importance, use generic terms such as “stress”, and generally present to primary medical doctors rather than specialty mental health settings. In terms of treatment, few studies of exposure-based psychotherapies are randomized, older adults are rarely enrolled, and almost none evaluate the most evidence-based psychotherapy for PTSD, Prolonged Exposure therapy. Analyses of prescribing trends using Veterans Affairs (VA) databases suggest that only about half of veterans (all ages) with PTSD receive first-line pharmacotherapy agents such as selective serotonin reuptake inhibitors (SSRIs), with even lower medication prescription in older compared to younger adults.In this symposium the influence of age-related factors will be discussed on the prevalence, development of PTSD given a traumatic stimulus, clinical presentation in terms of symptom profiles, underlying neurobiology, treatment responsivity, and illness course. Speakers will engage the audience in a discussion of what makes PTSD different in older adults compared to younger adults and what are the implications of these differences on clinical evaluation and treatment. Dr. Joan Cook will present data comparing characteristics of younger vs. older sexual assault survivors in order to discuss clinical and research implications. Next, Dr. Vanessa Simiola will present electronic health record and utilization data and discuss age-based differences between diagnoses made in primary care versus specialty mental health, differences in mental health treatment receipt, as well as clinical characteristics of the samples. Then, Dr. Xi Zhu will delve into data suggesting higher rates of MDD in older adults with PTSD and present her analyses of network connectivity differences discriminating PTSD from comorbid PTSD/MDD. Finally, Dr. Bret Rutherford will present data from an ongoing NIMH study in which older adults with PTSD are compared to trauma-exposed healthy controls (TEHCs) on cognitive, physical functioning, and neuroimaging indices. Two-year follow up data will be reviewed to consider the differing cognitive and physical functioning trajectories experienced over time between PTSD and TEHC participants. Finally, an audience discussion synthesizing all three of the talks will be held, with ample opportunity for audience members to ask questions of each speaker.

Buprenorphine as a Treatment for Major Depression and Opioid Use Disorder.

Rates of major depressive disorder (MDD) are disproportionally high in subjects with opioid use disorder (OUD) relative to the general population. MDD is often more severe in OUD patients, leading to compliance issues with maintenance therapies and poor outcomes. A growing body of literature suggests that endogenous opioid system dysregulation may play a role in the emergence of MDD. Buprenorphine, a mixed opioid receptor agonist/antagonist approved for the treatment of OUD and chronic pain, may have potential as a novel therapeutic for MDD, especially for patients with a dual diagnosis of MDD and OUD. This paper presents a comprehensive review of papers relevant to the assessment of buprenorphine as a treatment for MDD, OUD, and/or suicide compiled using electronic databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The principal goal of this literature review was to compile the clinical studies that have interrogated the antidepressant activity of buprenorphine in opioid naïve MDD patients and OUD patients with comorbid MDD. Evidence supporting buprenorphine's superiority over methadone for treating comorbid OUD and MDD was also considered. Finally, recent evidence for the ability of buprenorphine to alleviate suicidal ideation in both opioid-naïve patients and opioid-experienced patients was evaluated. Synthesizing all of this information, buprenorphine emerges as a potentially effective therapeutic for the dual purposes of treating MDD and OUD.

Social Buffering is Dependent on Mutual Experience in Adolescent Male Mice Exposed to Social Defeat Stress

Background Individuals who experience emotional, physical, or sexual abuse as children suffer from higher rates of major depressive disorder, drug abuse, and suicide. Early life interventions such as peer support groups can be beneficial to adolescents who experience trauma, suggesting that social support is important in facilitating rehabilitation and promoting resiliency to stress. Although there are some animal paradigms that can model how peer-peer interactions influence stress-reactivity, less is known about how individual stress experiences influence the effectiveness of social buffering. Methods The vicarious social defeat stress (VSDS) paradigm allows for the assessment of two different stress modalities, physical (PS) and emotional (ES) stress, which confer different levels of stress with similar biological and behavioral outcomes. Using a modified VSDS paradigm in which pairs of mice experience ES and PS together we can begin to evaluate how stress exposure influences the buffering efficacy of social relationships. Adolescent mice (postnatal day 35) were randomly combined into dyads and were allocated into either mutual experience or cohabitation pairs. Within each dyad, one mouse was assigned to the physically stressed (PS) condition and was repeatedly exposed to an aggressive CD1 mouse while the other mouse was designated as the partner. In the mutual experience dyads the partner mice witnessed the defeat bout (ES) while in the cohabitation dyads the partner was separated from the PS mouse and returned after the 10 min defeat bout was terminated (non-stressed). After 10 days of defeat, mice were tested in the social interaction test (SIT), the elevated plus maze (EPM), and the forced swim test (FST). Results PS-exposed mice in the cohabitation dyads, but not those in the mutual experience dyads, showed significantly more avoidance of a novel CD1 aggressor or c57BL/6 mouse, in the SIT. Surprisingly, both partner conditions showed avoidance to a CD1. Interestingly, non-stressed partner mice spent less time in the open arms of the EPM, suggesting increased anxiety; only PS-exposed mice in cohabitation dyads showed more time spent immobile in the FST, indicative of increased learned helplessness. Conclusions These data suggest that the efficacy of social buffering can be mediated by individual stress experience.

Sex-Based Impact of Creatine Supplementation on Depressive Symptoms, Brain Serotonin and SSRI Efficacy in an Animal Model of Treatment-Resistant Depression.

Background: Rates of major depressive disorder (MDD) increase with living at altitude. In our model, rats housed at moderate altitude (in hypobaric hypoxia) exhibit increased depression-like behavior, altered brain serotonin and a lack of antidepressant response to most selective serotonin reuptake inhibitors (SSRIs). A forebrain deficit in the bioenergetic marker creatine is noted in people living at altitude or with MDD. Methods: Rats housed at 4500 ft were given dietary creatine monohydrate (CRMH, 4% w/w, 5 weeks) vs. un-supplemented diet, and impact on depression-like behavior, brain bioenergetics, serotonin and SSRI efficacy assessed. Results: CRMH significantly improved brain creatine in a sex-based manner. At altitude, CRMH increased serotonin levels in the female prefrontal cortex and striatum but reduced male striatal and hippocampal serotonin. Dietary CRMH was antidepressant in the forced swim test and anti-anhedonic in the sucrose preference test in only females at altitude, with motor behavior unchanged. CRMH improved fluoxetine efficacy (20 mg/kg) in only males at altitude: CRMH + SSRI significantly improved male striatal creatine and serotonin vs. CRMH alone. Conclusions: Dietary CRMH exhibits sex-based efficacy in resolving altitude-related deficits in brain biomarkers, depression-like behavior and SSRI efficacy, and may be effective clinically for SSRI-resistant depression at altitude. This is the first study to link CRMH treatment to improving brain serotonin.

Does the millennial generation of women experience more mental illness than their mothers?

BackgroundThere is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age.MethodsPregnant women were recruited during 1981–1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008–11). Offspring were administered the CIDI at the 30-year follow-up (2010–2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes.ResultsWhen comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD.ConclusionsIn the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio.

In rural southeastern Ohio, the prevalence of diabetes is 19.9%, nearly double the national average of 10.5%. Despite the high rate of diabetes, its impact on the region is understudied; one such understudied topic is psychosocial difficulties. People with diabetes experience disproportionately higher rates of major depressive disorder (MDD), clinically significant depressive symptoms, and diabetes distress. Diabetes distress refers to the negative emotional experience of living with diabetes. It reflects an individual's worries, concerns, and fears about living a chronic and progressive disease. To assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life (DQOL). In this cross sectional survey study, individuals aged 18years and older, diagnosed with type 1 (T1D) or type 2 (T2D) diabetes, who were able to read and speak English, and living in southeastern Ohio were invited to participate. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Self Care Inventory-Revised, and the DQOL Scale as part of the study survey. Participants completed the survey via an online questionnaire service or mailed packets. Chi square tests determined the comorbidity of clinically significant depressive symptoms and high diabetes distress levels by type of diabetes. Multiple regression models examined the relationships among clinically significant depressive symptoms, diabetes distress scores, A1C levels, self care behaviors, and DQOL scores. Statistical significance was defined as a p<0.05. A total of 325 adults participated (mean±standard deviation [SD] age, 41.6±19.2years; 131 (40.7%) with T1D; 194 (59.7%) with T2D; mean±SD A1C, 7.5±1.6%; mean±SD duration, 12.4±9.6years). Of the 325 participants, 70 (21.5%) indicated clinically significant depressive symptoms, with 29 (22.3%) T1D participants and 41 (21.0%) T2D participants reporting clinically significant depressive symptoms. A total of 92 (28.3%) participants reported high diabetes distress (39 (30.5%) T1D participants and 53 (27.5%) T2D participants). Forty-eight participants (15.0%) screened positive for both clinically significant depressive symptoms and high diabetes distress. Regression models showed that higher diabetes distress scores were associated with fewer self care behaviors (T1D, b=-0.268, p=0.030; T2D, b=-0.312, p<0.001) and lower DQOL (T1D, b=0.726, p<0.001; T2D, b=0.501, p<0.001). Further, more depressive symptoms were associated with lower DQOL in participants with T2D (b=0.363, p<0.001). Higher diabetes distress scores were not associated with higher A1C levels in participants with T1D or T2D; however, increased depressive symptoms were associated with higher A1C levels in participants with T2D (b=0.390, p<0.001). Findings showed that adults in southeastern Ohio experienced high levels of diabetes distress and co-occurring clinically significant depressive symptoms that were within range of data from previous studies. These findings highlight the importance of routine screening for both clinically significant depressive symptoms and diabetes distress. Future longitudinal research is needed to confirm these findings and examine the evolution of these relationships over time.

Explore the Underlying Mechanism Between Atopic Dermatitis and Major Depressive Disorder.

Adult patients with atopic dermatitis (AD) present relatively higher rates of major depressive disorder (MDD). However, the underlying mechanism is largely unknown. Here, we first conducted a systematic literature-based data mining to identify entities linking AD and MDD, including proteins, cells, functional classes, and small molecules. Then we conducted an AD-RNA expression data-based mega-analysis to test the expression variance of the genes that were regulators of MDD. After that, a Fisher Exact test-based pathway enrichment analysis (PEA) was performed to explore the AD-driven MDD-genetic regulators’ functionality. We identified 22 AD-driven entities that were up-stream MDD regulators, including 11 genes, seven small molecules, three functional classes, and one cell. AD could exert a promoting effect on the development of MDD. Four of the 11 genes demonstrated significant expression changes in AD patients in favor of the development of MDD. PEA results showed that AD mainly drives cytokine/chemokine regulation and neuroinflammatory response-related pathways to influence the pathological development of MDD. Our results supported the promotion role of AD in the pathological development of MDD, including the regulation of multiple genetic regulators of MDD involved in cytokine/chemokine regulation and inflammatory response.