Treatment Of Depression Research Articles

Comparing In-Person, Telephonic, and Video-Based Treatment of Depression in Adult Primary Care During the COVID-19 Pandemic.

The COVID-19 pandemic forced a rapid shift toward virtual modalities for the treatment of depression in primary care. Participants were adults 18 years and older with a new episode of depression diagnosed in primary care between March 1, 2020, and May 21, 2021, and moderate-to-severe symptoms of depression at the time of diagnosis (N = 9619). Outcomes were 1) antidepressant medications prescribed and dispensed (referred to as received), as well as adherence to those medications; 2) referrals made to depression-related services and the receipt of those services; and 3) a follow-up visit completed with the diagnosing practitioner regardless of treatment actions. Patients were 42.4 ± 17.8 years old, and 77.6% had moderate-to-severe symptoms at diagnosis. Most patients were women (70.4%), 48.2% were Hispanic, and 8.4% were Black. Telephone visits were associated with 64% increased odds of having an antidepressant prescribed when compared to in-person visits. However, patients prescribed an antidepressant during a telephone visit were 52% less likely to receive this prescription when compared to patients who were prescribed an antidepressant during an in-person visit. Telephone and video visits were associated with 48% and 37% decreased odds, respectively, of having a follow-up visit with the prescribing practitioner when compared to an in-person visit. Telemedicine for depression in adult primary care may result in greater antidepressant prescribing than in-person care, but these medications are less likely to be received. This study's findings suggest that health systems should adjust electronic decision support tools (such as mail-order pharmacies) to ensure virtual care decisions are implemented.

Consistent evidence that brain serotonin 2A receptor binding is positively associated with personality-based risk markers of depression.

Using [18F]altanserin, a serotonin 2A receptor (5-HT2AR) antagonist Positron Emission Tomography (PET) tracer, a positive association between cortical 5-HT2AR binding and the inward-directed facets of neuroticism has been demonstrated in healthy individuals. Psilocybin, a 5-HT2AR agonist, shows promise for the treatment of depression, reducing neuroticism and mood symptoms potentially via hypothalamic-pituitary-adrenal (HPA) modulation. 5-HT2AR and neuroticism are both modulated by HPA axis function. In this study, we examined whether the association between 5-HT2AR binding and the inward facets of neuroticism can be replicated in an independent healthy cohort using the new 5-HT2AR agonist tracer [11C]Cimbi-36, and if their association is moderated by cortisol awakening response (CAR), an index of HPA axis function. If so, this could advance mechanistic insights into interventions that target the 5-HT2AR and reduce neuroticism. Eighty healthy volunteers underwent [11C]Cimbi-36 PET scans and completed the NEO personality inventory (NEO-PI-R) for the assessment of neuroticism. Salivary samples were available for determination of CAR in 70 of the participants. Using linear latent variable models, we evaluated the association between 5-HT2AR binding and inward facets of neuroticism, namely depression, anxiety, self-consciousness and vulnerability to stress, and whether CAR moderated this association. The study confirms the positive association between 5-HT2AR binding and the inward facets of neuroticism (β = 0.01, 95% CI = [0.0005: 0.02], P = 0.04), and this association is independent of CAR (P = 0.33). The findings prompt consideration of whether novel interventions such as psilocybin that actively targets 5-HT2AR and causes changes in personality could be particularly beneficial if implemented as a targeted approach based on neuroticism profiles.

Diet interventions for depression: Review and recommendations for practice.

this paper aims to present the evidence for the role of diet in the prevention and treatment of depression, review the potential underlying mechanisms and provide practice recommendations for mental health clinicians. A literature review was conducted through searches of PubMed with the search terms 'depression', 'diet', 'prevention', 'treatment' and 'mechanisms' and combinations thereof. Additional articles were identified through hand searching. Greater adherence to several healthy dietary patterns, traditional diets such as the Mediterranean diet and other diets such as the DASH diet are associated with or can treat symptoms of depression. Several limitations of the research were noted, many of which relate to inherent challenges of studying diet. Mechanisms by which dietary intervention can influence mood include the gut microbiome, modulation of inflammatory processes, reduction in oxidative stress and modulation of hypothalamic-pituitary-adrenal axis function. Recommendations for mental health clinicians to enable translation of the evidence into practice are provided. Diet can play an important role in preventing and treating depression. Mental health clinicians are well placed to provide dietary counselling and to use clinical judgement in choosing the specific approach that reflects the needs of the patient but are encouraged to refer to a specialist dietitian where necessary.

The hypothalamic-pituitary-thyroid axis, depression and risk of suicide: commentary, Luo et al.

There is a considerable literature on the relationship of thyroid function with risk of depression and responsiveness to depression treatment. This literature is briefly reviewed here, followed by a focus on the incremental advance provided by the findings of Luo et al on autoimmune thyroiditis and suicide attempts.

Uncovering the effects and mechanisms of tea and its components on depression, anxiety, and sleep disorders: A comprehensive review

Depression, anxiety and sleep disorders are prevalent psychiatric conditions worldwide, significantly impacting the physical and mental well-being of individuals. The treatment of these conditions poses various challenges, including limited efficacy and potential side effects. Tea, a globally recognized healthful beverage, contains a variety of active compounds. Studies have shown that consuming tea or ingesting its certain active ingredients have a beneficial impact on the mental health issues mentioned above. While the effects of tea on physical health are well-documented, there remains a gap in our systematic understanding of its impact on mental health. This article offers a thorough overview of animal, clinical, and epidemiological studies examining tea and its components in the treatment of depression, anxiety, and sleep disorders, and summarizes the associated molecular mechanisms. The active ingredients in tea, including L-theanine, γ-aminobutyric acid (GABA), arginine, catechins, theaflavins, caffeine, theacrine, and several volatile compounds, may help improve depression, anxiety, and sleep disorders. The underlying molecular mechanisms involve the regulation of neurotransmitters, including monoamines, GABA, and brain-derived neurotrophic factor (BDNF), as well as the suppression of oxidative stress and inflammation. Additionally, these ingredients may influence the microbiota-gut-brain (MGB) axis and the hypothalamic–pituitary–adrenal (HPA) axis. This review provides valuable insights into the effects and mechanisms by which tea and its components regulate depression, anxiety, and sleep disorders, laying the groundwork for further research into relevant mechanisms and the development of tea-based mental health products.

The Mediating Role of Depressive Symptoms and Treatment Burden on Health-Related Quality of Life Among Multimorbid Patients With Hypertension: A Multi-Group Analysis.

Multimorbidity negatively affects health-related quality of life (HRQoL), though the underlying mechanism remained unclear. This study aims to investigate the mediating role of depressive symptoms and multimorbidity treatment burden (MTB) in the association between disease burden and HRQoL in multimorbid patients with hypertension and to determine differences in mediating effects between and within age groups (< 60 years vs. 60 and above). Disease burden, depressive symptoms, MTB, and HRQoL were assessed by self-reported questionnaires. We conducted path analysis with all subjects and multi-group path analyses with two age groups. Results from the path analysis with all subjects (n = 498) showed a significant direct effect of disease burden on HRQoL and a significant indirect effect via depressive symptoms and MTB. No significant differences in mediating effects were found between age groups. However, in the older patients, depressive symptoms had a greater indirect effect than MTB. Our results underscore the importance of addressing both depressive symptoms and MTB in interventions tailored to the patient's age.

Experimental study on the effect of Mongolian medicine warming acupuncture on proBDNF-tPA-BDNF balance in depression rats based on thermal imaging monitoring

Depression is a kind of mental illness affecting the whole world. Its pathological mechanism is complex, involving neurobiological and psychosocial factors.The depression model rats were randomly divided into control group, warm acupuncture group and drug treatment group. In order to evaluate the local thermal effect of warm acupuncture and moxibustion, real-time temperature changes of rat forebrain were monitored by thermal imaging technology. After the experiment, immunohistochemistry and Western blot were used to detect the expression levels of tPA and BDNF in the forebrain of each group of rats, and the relationship between tPA and BDNF was analyzed. The results of thermal imaging monitoring showed that local forebrain temperature in warm acupuncture group was significantly increased compared with control group (p < 0.05). The ratio of tPA to BDNF was significantly improved in the warm acupuncture and moxibustion group, suggesting that warm acupuncture and moxibustion can effectively regulate the balance of TPA-BDNF. The experimental results based on thermal imaging monitoring suggest that warm acupuncture can improve the balance of TPA-BDNF in the forebrain of depressed rats by promoting the expression of BDNF and tPA in the forebrain, which may provide a new method and mechanism basis for the treatment of depression.

A Survey of the Clinical Practice Status of Korean Medicine Doctors for Depression: Preliminary Data on Clinical Practice Guidelines

Objectives: Although antidepressants and cognitive behavioral therapy are first-line therapies for patients with depression, they have some limitations. Korean medicine has been traditionally used in Korea to manage depression; however, the current clinical practice status of depression treatment by Korean medicine doctors (KMDs) is unknown. Therefore, this study aimed to investigate the current clinical practice status of KMDs for depression.Methods: KMDs were surveyed online from October 2021 to November 2021. A total of 712 KMDs responded to the survey.Results: Hwabyung and depressive syndrome were the most frequently diagnosed conditions. Among the patients who initially visited the KM clinic, 51.3% were taking antidepressants, with the majority seeking treatment to alleviate physical symptoms associated with depression. Acupuncture and herbal medicine decoctions were the most commonly administered treatments, with body acupuncture being the preferred modality (average: 2.37 times per week). The preferred acupoints were GV20, HT7, PC6, LI4, SP6, and ST36.Conclusion: This survey provides insights into the clinical practice landscape of KMDs in treating depression. These results will help develop clinical practice guidelines and conduct clinical trials on this topic in the future.

Real-World Safety of Esketamine Nasal Spray: A Comprehensive Analysis of Esketamine and Respiratory Depression.

Esketamine nasal spray (ESK) is approved, in conjunction with an oral antidepressant, for the treatment of treatment-resistant depression in adults and for the treatment of depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. No adverse events (AEs) of respiratory depression were reported in ESK phase 3 clinical trials; however, postmarketing incidents of respiratory depression associated with ESK use have been observed. The Janssen Global Medical Safety (GMS) database was reviewed for cases meeting criteria for respiratory depression with ESK using 47 months of postapproval data, based on the Standardized Medical Dictionary for Regulatory Activities (MedDRA) preferred term (PT) acute central respiratory depression (broad). FAERS, EudraVigilance, and literature searches were performed to identify reports of respiratory depression related to ESK use. Fifty cases, representing 50 patients, in the GMS database met the case definition for respiratory depression; 8 of these had a stronger association with ESK use. The MedDRA PT hypopnea met the threshold for disproportionality with ESK in FAERS. The MedDRA PTs asphyxia, oxygen saturation decreased, respiratory depression, and apnea, met the threshold for disproportionality with ESK in EudraVigilance. Despite extensive soliciting of AEs for ESK with the US Risk Evaluation and Mitigation Strategy program, respiratory depression is infrequently observed with ESK treatment in the postmarketing setting (estimated incidence: 1 case per 20,000 treatment sessions). Symptoms are manageable and resolve with minor supportive measures. Monitoring for symptoms of respiratory depression, including pulse oximetry, is recommended within the postdose observation period.

Fluoxetine treatment reverses chronic stress-induced promotion on Fk506-binding protein 5 expression and multiple effects on glucocorticoid receptor phosphorylation in the paraventricular nucleus of mice

BackgroundFluoxetine is widely used as a first-line antidepressant. However, the molecular mechanisms for its antidepressant effects are still not fully understood. Hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is a core pathogenic mechanism contributing to depression, and fluoxetine treatment prevents this dysfunction. The glucocorticoid receptor (GR) is a major negative feedback regulator of the HPA axis, while Fk506-binding protein 5 (Fkbp5) is a negative regulator of the GR signaling. Therefore, we examined the effects of fluoxetine on Fkbp5 and the GR signaling in the hypothalamic paraventricular nucleus (PVN) of depressed mice. MethodsMice were exposed to chronic social defeat stress (CSDS), chronic unpredictable mild stress (CUMS), or chronic restraint stress (CRS) with or without fluoxetine treatment (intraperitoneally injected, 20 mg/kg) and examined for changes in depression-like behaviors and HPA axis activity as well as Fkbp5 expression and GR phosphorylation in the PVN. We then examined if adeno-associated virus (AAV)-mediated Fkbp5 overexpression in the PVN affected the antidepressant actions of fluoxetine in mice. ResultsFluoxetine treatment significantly mitigated CSDS-, CUMS-, and CRS-induced depression-like behaviors and HPA axis hyperactivity in mice. Subsequent western blotting analyses showed that fluoxetine treatment fully reversed not only chronic stress-induced upregulation of Fkbp5 and CRH but also chronic stress-induced increase in Ser203 phosphorylation and decrease in Ser211 and Ser234 phosphorylation in GR in the PVN. Moreover, quantitative real-time reverse transcription PCR (qRT-PCR) analyses revealed that the enhanced mRNA levels of Fkbp5 and CRH in PVN neurons of mice subjected to CSDS/CUMS/CRS were also notably reversed by fluoxetine administration. Conversely, Fkbp5 overexpression in the PVN significantly eliminated the antidepressant effects of fluoxetine in mice without affecting their locomotor activity. ConclusionThese results together suggest that fluoxetine treatment reverses chronic stress-induced promotion on Fkbp5 expression and multiple effects on GR phosphorylation in the PVN of mice. Significance statementThe selective serotonin reuptake inhibitor fluoxetine (sold as Prozac) is a widely used treatment for depression, but the full spectrum of therapeutic mechanisms is still debated. Recent evidence suggests that these therapeutic mechanisms include suppression of chronic stress-activated hypothalamus–pituitary–adrenal (HPA) axis. The current study presents the first in vivo evidence showing that suppression of HPA axis hyperactivity by fluoxetine treatment involves reversal of glucocorticoid receptor (GR) phosphorylation via modulation of the GR negative regulator Fk506-binding protein 5 (Fkbp5) in the hypothalamic paraventricular nucleus (PVN). Fluoxetine treatment not only inhibited chronic stress-induced depression-like behaviors and HPA axis hyperactivity but also reversed Fkbp5 upregulation and GR phosphorylation changes in the PVN, while adeno-associated virus (AAV)-based Fkbp5 overexpression in the PVN eliminated the antidepressant effects of fluoxetine. These findings may expand our understanding of the pharmacological effects of fluoxetine, and further identify Fkbp5 as a possible target for novel antidepressants.

The application of integrating electroencephalograph-based emotion recognition technology into brain–computer interface systems for the treatment of depression: a narrative review

Dysregulation of the prefrontal cortex, amygdala, and hippocampus, along with alterations in P300 amplitude and abnormalities in the theta and beta bands, has been closely linked to the onset and pathophysiology of depression. Consequently, integrating electroencephalograph-based emotion recognition technology into brain‒computer interface systems offers the potential for real-time identification and modulation of emotional states through continuous interaction between the brain‒computer interface system and brain activity. This closed-loop system could precisely control neural stimulation in brain regions associated with emotional disorders, potentially alleviating the distressing memories of traumatic events. Although the efficacy of the brain‒computer interface in treating depression still requires validation through extensive clinical trials, its inherent real-time feedback and adaptive capabilities present a promising avenue for depression therapy. This review aims to explore the neuroanatomical mechanisms and neural activity patterns associated with depression and evaluate the potential of brain‒computer interface technology as a treatment modality. The objectives include summarizing key brain regions and neural networks involved in depression, analyzing their activity patterns, and assessing the impact of brain‒computer interface technology on these regions to provide theoretical support for future clinical trials. Significant functional abnormalities have been identified in the prefrontal cortex, amygdala, and hippocampus of patients with depression. The gray matter density, functional connectivity, and neural activity in these regions are closely associated with the severity of depressive symptoms. Common features in patients with depression include a reduced P300 amplitude and increased θ and α current density. Brain‒computer interface technology has demonstrated potential in modulating these abnormal neural activities, particularly in emotion recognition and regulation. When combined with techniques such as repetitive transcranial magnetic stimulation and deep brain stimulation, brain‒computer interface may provide effective interventions for managing emotional states in patients with depression. This review confirms the association between depression and functional abnormalities in specific brain regions and suggests that brain‒computer interface technology offers promising therapeutic potential by modulating abnormal neural activity. Brain‒computer interface could represent a novel treatment approach for depression. Future research should focus on validating the practical applications, efficacy, and safety of brain‒computer interface in treating depression.

Psychological Well-Being Among Nursing Staff in an Emergency Department: A Mixed-Methods Study

IntroductionEmergency departments worldwide are faced with in-hospital crowding and fast-paced admissions, creating an increasingly high workload for health care personnel. In recent years, emergency departments have also experienced an increase in emergency admissions, resulting in burdened workplaces. This has led to debates about nurses’ work environment and mental well-being. This study aimed to gain knowledge on the prevalence of depression, anxiety, and stress, as well as insight into the factors influencing the mental well-being of the nursing staff in a Danish emergency department. MethodsThis is a mixed-methods study with an explanatory sequential design. A questionnaire (the Depression, Anxiety, and Stress Scale – 21 Items) was sent to nursing staff (N = 146) in a large emergency department in the Region of Southern Denmark. Afterward, a smaller sample participated in semistructured interviews. The quantitative data were analyzed using descriptive statistics, the Mann–Whitney U test, and the chi-square test. In the qualitative part, a thematic analysis was performed. ResultsCompleted surveys were received from 78 nursing staff (53.4%). Overall, the nursing staff reported severe to extremely severe levels of depression (14.1%), anxiety (23.1%), or stress (47.2%) within a week before completing the survey. Higher levels of psychological distress were significantly associated with fewer years of clinical experience and having previously experienced or received treatment for depression, anxiety, or stress. Ten staff members later volunteered to participate in the interviews. The qualitative results formed 3 themes: (1) high work pace and responsibility, (2) professional community and nursing identity, and (3) culture with an increased focus on mental well-being. DiscussionThe nursing staff reported high mental strain, especially in the forms of high stress and anxiety levels. They explained that their mental health was affected by overcrowding, a pressured work environment, and lack of resources.

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

Exploring the effects of erythropoietin treatment on cortical thickness and hippocampal volume in patients with mood disorders undergoing electroconvulsive therapy: A randomized, placebo-controlled trial.

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, its utilization is limited to the most severely ill patients due to stigma, healthcare provider unfamiliarity, and concerns regarding cognitive side effects. Erythropoietin (EPO) is a promising add-on treatment during ECT due to its potential to increase neuroplasticity and cognition. To explore the effects of EPO administration on cortical thickness and hippocampal volumes. In a randomized, double-blinded, placebo-controlled trial, we previously investigated the impact of EPO (40,000 IU) versus placebo (saline) infusions on cognitive side effects of unipolar or bipolar depression patients undergoing eight ECT sessions over 2.5 weeks. This cross-sectional magnetic resonance imaging study explores the effect of EPO on cortical thickness and hippocampal volumes 3 days post-ECT in 37 of the EPO trial patients (EPO n = 21; placebo n = 16). Compared to the placebo group, EPO-treated patients displayed thicker cortex in distributed regions of the right hemisphere, predominantly in the parietal and occipital areas. There were no significant group differences in the hippocampal volumes or prefrontal cortex thickness. EPO treatment may produce a selective increase in the right-side occipito-parietal cortical thickness. In contrast, the thickness of other cognition-relevant structures was not significantly affected. This aligns with our previously reported finding that EPO has a selective effect on autobiographical memory and associated right-side parietal activity in the absence of changes in global cognition. It remains to be investigated whether longer EPO treatment and follow-up assessment may be necessary for overt structural changes in cognition-relevant brain networks.

Encapsulation of fluoxetine by cucurbit[7]uril: A computational and experimental study

Fluoxetine (FLX), a selective serotonin reuptake inhibitor, is widely prescribed for the treatment of depression and obsessive-compulsive disorders. However, the administration of FLX can lead to side effects, which may be mitigated by encapsulating the drug within a macrocyclic host. In this study, we explored the complexation of FLX with cucurbit[7]uril (CB7) using 19F and 1H NMR spectroscopy, fluorescence displacement titrations, and molecular dynamics (MD) simulations. Our fluorescence results indicate that CB7 forms a 1:1 complex with FLX, with a binding constant of 1.7 × 10³ M−1. Additionally, NMR data suggest that the (trifluoromethyl) phenyl moiety of FLX is encapsulated within the CB7 cavity. Molecular dynamics simulations revealed two binding modes for FLX with CB7: one involving the inclusion of the (trifluoromethyl) phenyl moiety and the other involving the phenyl moiety within the CB7 cavity. In both modes, the protonated amine group of FLX interacted with the CB7 portal. Binding free energy calculations using the MM-PBSA method suggested a preference for the inclusion of the phenyl moiety, which contrasts the NMR findings. The interactions between the host and guest were primarily driven by electrostatic forces, with van der Waals interactions playing a lesser, but still favorable, role. In contrast, DFT calculations produced similar binding free energy estimates for the two modes.

SEP-363856 attenuates CUMS-induced depression-like behaviours and reverses hippocampal neuronal injuries

Objectives This study employed a chronic unpredictable mild stress (CUMS) model to examine the antidepressant properties of SEP-363856. Methods The sucrose preference test (SPT) was employed to evaluate anhedonia, the open field test (OFT) to measure locomotor activity and exploratory behaviour, the elevated plus-maze (EPM) to assess anxiety-like behaviour, and the tail suspension test (TST) and forced swimming test (FST) to determine despair behaviour. qRT-PCR was implemented to evaluate gene expression levels in the hippocampus. Western blot, and ELISA were implemented to evaluate hippocampal protein expression, and Nissl staining was implemented to identify hippocampal neuronal injury. Results The 10 mg/kg dosage of SEP-363856 and fluoxetine significantly improved depressive-like behaviours as assessed by the SPT, OFT, EPM, TST, and FST. This was associated with improved hippocampal neuronal damage, enhanced mRNA expression of brain-derived neurotrophic factor, synaptophysin, and postsynaptic density 95. SEP-363856 increased the levels of insulin-like growth factor-1 (IGF-1), IGF-1 receptor β, phospho-phosphatidylinositide 3-kinase, and phospho-protein kinase B in the brain. Conclusions The antidepressant-like effects of SEP-363856 are linked to increased hippocampal neurotrophic factors, decreased hippocampus neuronal lesions, and activation of the IGF-1Rβ/PI3K/AKT signalling pathway. The latter may serve as a novel drug target for the treatment of depression.

Investigating the Possibilities of Applying the TENS as a Neurostimulation Method

Transcranial electrical stimulation (TES) is a non-invasive technology used to change the functions of the nervous system as one of the methods of neuromodulation. This method modulates brain activity by applying low-intensity electrical current to different regions of the brain. The use of transcranial electrical stimulation has shown promising results in the treatment of depression, chronic pain, neurodegenerative diseases and other neurological problems. Research shows that the application of transcranial electrical stimulation can be effective in areas such as improving memory, developing motor skills and increasing cognitive functions. However, safety, efficacy, and individual differences should be considered when using this method in clinical practice. The article examines the clinical and scientific basis, applications, and potential benefits of transcranial electrical stimulation. It is very important to study the parameters such as the shape, amplitude and frequency of the influencing signal used for the optimal solution of the treatment process. In the article, the types of the effective signal in transcranial electrical stimulation were investigated. The role of different forms of affective signals on the effectiveness of neurostimulation was investigated. In addition, it was concluded that electroacupuncture stimulation belongs to neurostimulation in terms of its essence and parameters.

Is the diagnosis and treatment of depression gender-biased? Evidence from a population-based aging cohort in Sweden

BackgroundAs compared to men, older women´s higher rates of depression diagnosis and antidepressant use are widely reported. We aimed to: a) explore whether there is a potential gender bias in the clinical diagnosis of depression and antidepressant prescription in an older population from Stockholm; and 2) analyze if such gender bias differs by patients’ age and socioeconomic status.MethodsWe used data from the Swedish National Study on Aging and Care in Kungsholmen, SNAC-K (N = 2,941). We compared gender differences in: (a) clinical diagnosis of depression according to the Swedish National Patient Register (ICD-10 codes F32-F34; F412) (“register-based diagnosis”); (b) SNAC-K-based diagnosis of depression, partially gender-blind, using the Comprehensive Psychopathological Rating Scale (CPRS) and the DSM-IV-TR (“SNAC-K based diagnosis); and (c) antidepressant use (ATC code N06A). To analyze the magnitude of the gender bias in the register-based diagnosis of depression and in antidepressant use, and the role of potential moderating factors, prevalence ratios (PR) were calculated using Poisson regression models. Models were run separately by age and social class.ResultsWomen had a 63% higher probability of having a register-based diagnosis of depression (PR = 1.63[1.23–2.15]) and a 79% higher probability of using antidepressants (PR = 1.79[1.34–2.40]). No gender differences were observed in the SNAC-K-based diagnosis of depression. The gender differences in the register-based diagnosis were narrowed, although remained significant, after considering age, depressive symptoms, and health services use (PR = 1.44[1.10–1.88]), as well as the register-based diagnosis in the case of antidepressant use (PR = 1.31[1.04–1.64]). This gender bias was larger among the younger-old and the most advantaged social class.ConclusionA gender-bias was identified in the diagnosis and treatment of depression in older adults within the Swedish healthcare setting, which could imply that health services may be contributing to the medicalization of women’s mental health. Gender-sensitive clinical and public health interventions are essential to reduce gender disparities in mental healthcare, also in old age.

An Evaluation of VYC-17.5L for the Treatment of Marionette Lines: A Prospective, Open-Label, Postmarketing Study.

Marionette lines are a feature of the aging face, descending from the oral commissures towards the jaw. VYC-17.5 L is a dermal filler that contains 17.5 mg/mL of hyaluronic acid (HA) and lidocaine (3 mg/mL); it is intended for the treatment of skin depressions. VYC-17.5 L has been shown to be safe and effective in different conditions, but there is a lack of published literature on its effectiveness in marionette lines. This 12-month prospective, open-label, post-marketing study evaluated the effectiveness and safety of the injectable HA filler VYC-17.5 L for the improvement of marionette lines. Adults (≥ 18 years) with mild-to-severe marionette lines on the validated Allergan Marionette Line Scale (AMLS) received VYC-17.5 L on Day 1 with optional touch-up on Day 14. The primary endpoint was proportion of participants with ≥ 1-point change in AMLS from baseline at Month 1 (M1). Secondary endpoints were investigator- and participant-rated Global Aesthetic Improvement Scale (GAIS), FACE-Q satisfaction with facial appearance, and appraisal of lines: marionette. Safety was assessed throughout. A total of 83 participants completed the study; 69.9% of participants had ≥ 1-point change in AMLS at M1. Investigator and participant GAIS showed improvement. Both FACE-Q scores significantly improved from baseline (p < 0.0001). A significant volume improvement was seen and maximized at M1. Most participant-reported injection site reactions were mild or moderate and resolved within 8 days; 14 subjects reported adverse device effects, with the most common being pain, which resolved within 8 days. This prospective, open-label study showed that VYC-17.5 L effectively improved marionette lines and was well tolerated.

Four weeks standard vs. one week accelerated intermittent Theta Burst Stimulation for the treatment of depression – A retrospective analysis

IntroductionIntermittent Theta Burst Stimulation (iTBS), a specific form of repetitive transcranial magnetic stimulation (rTMS) is increasingly used for treating affective disorders. Accelerated iTBS protocols (aiTBS) with shorter treatment duration may lead to equal but faster response rates compared to standard protocols. MethodsHere, we retrospectively analyzed the records of 66 rTMS in- and out-patients with major depressive disorder in a tertiary care hospital between April 2023 and September 2023. All patients received left prefrontal iTBS with 1200 pulses, either one session/workday over 4 weeks (n = 34) or left prefrontal aiTBS on five sessions/workday for one week (n = 32). Depressive symptoms were assessed with the 21-item Hamilton Depression Rating Scale (HAMD-21) and the Major Depression Inventory (MDI) before and at the end of the respective treatment. ResultsWith both treatments, iTBS and aiTBS, the severity of depression improved significantly according to HAMD-21 and MDI. Response rates for iTBS were 38 % (HAMD-21) and 35 % (MDI), for aiTBS 19 % (HAMD-21) and 16 % (MDI), respectively. Remission rates showed a similar pattern. Effect sizes for group differences were small to medium. No serious adverse events occurred in any group. Tolerability was lower in aiTBS. Overall satisfaction was low for aiTBS on a qualitative and subjective level. ConclusionaiTBS with 1200 pulses and five daily sessions lead to amelioration of symptoms within one week. But benefit, satisfaction, tolerability was slightly lower in contrast to four weeks of iTBS. For everyday clinical practice, aiTBS protocols can be considered after weighing up the logistical disadvantages, such as possible longer waiting time for new patients that want to start a therapy with TMS. Future studies should explore the optimal dosage regime (number of sessions per day, number of pulses per session) for fast and effective symptom reduction.