Treatment Of Anxious Depression Research Articles

Zhi Zi Chi decoction (Gardeniae fructus and semen Sojae Praeparatum) attenuates anxious depression via modulating microbiota-gut-brain axis in corticosterone combined with chronic restraint stress-induced mice.

The microbiota-gut-brain axis plays a critical role in neuropsychiatric disorders, particularly anxious depression, and attracts more attention gradually. Zhi Zi Chi decoction (ZZCD) consisting of Gardenia jasminoides J. Ellis and Glycine max (L.) Merr, is a classic formula in clinic and widely applied in anxiety and depression treatment. However, the underlying mechanisms of regulating microbiota-gut-brain axis in the treatment of anxious depression by oral administration of ZZCD remain elusive. In this project, we clarified the origin and preparation methods of the Gardenia jasminoides J. Ellis and Glycine max (L.) Merr and examined the chemical ingredients of ZZCD by liquid chromatograph mass spectrometer. Then, corticosterone combined with chronic restraint stress was applied to establish an anxious depression model. After treated with ZZCD standard decoction, based on enzyme-linked immunosorbent assay (ELISA), 16S rRNA technology, high-throughput sequencing, quantitative RT-PCR and fecal microbiota transplantation (FMT), the multiple associations between nucleus accumbens and intestinal flora in anxious depression mice were determined to clarify the mechanism of ZZCD in the treatment of anxiety and depression disorder. We found various substances with antidepressant and antianxiety properties in ZZCD such as rosiridin and oleanolic acid. ZZCD could alleviate depressive and anxiety behaviors in anxious depression mice via regulating the disturbance of gut microbiota. Meanwhile, the bioactive compounds of ZZCD might directly active on neurodevelopment and neuroimmune-related genes. Furthermore, the secretion of prolactin and estrogen, and interfering with mitogen-activated protein kinase (MAPK) and tumor necrosis factor (TNF) signaling pathways were mainly involved in the multi-target therapeutic effects of ZZCD against anxiety and depression. These findings suggested that ZZCD exerts antidepressant effects pleiotropically through modulating the microbiota-gut-brain.

Cortisol rhythm disorder and influencing factors of patients with anxious depression

Objective To explore the relationship between anxious depression and cortisol rhythm disorder and influencing factors of immune metabolism.And to look for biological markers that can be used for clinical diagnosis and treatment of anxious depression. Methods Totally 43 patients with anxious depression(A-MDD group) and 44 patients with non-anxious depression matched by sex, age and years of education(NA-MDD group)were recruited.Electrochemiluminescence was used to detect the plasma levels of adrenocorticotropic hormone(ACTH), cortisol(COR), c-reactive protein(CRP) and IL-6.Automatic biochemical analysis was used to detect plasma total TC, TG, HDL and LDL.Using logistic regression analysis to discuss the influencing factors of anxiety depression. Results The comparison between the two group showed that the age of first onset, BMI and SBP in the A-MDD group((35.15±11.56), (24.11±3.03)kg/m2, (130.09±13.33)mmHg) were significantly higher than those in the NA-MDD group((31.34±14.08), ( 22.70±3.19)kg/m2, ( 121.89±12.49)mmHg)(t=2.631, 2.009, 2.964, all P<0.05). The HAMD score and the factor scores of cognitive impairment, change of day and night, delay, sleep disorder and feeling of despair in the A-MDD group((31.81±5.39), (8.03±3.00), (1.17±0.70), (6.88±1.93), (4.44±1.44), (4.67±2.37)) were significantly higher than those in the NA-MDD group((25.25±5.017), (3.87±3.12), (0.79±0.78), (4.64±2.22), (3.34±1.54), (3.61±2.02))(t=2.297, 6.524, 2.505, 5.210, 3.452, 2.421, all P<0.05). The plasma TG, CRP and IL-6 levels in the A-MDD group((1.63±1.11)mmol/L, (1.20±0.77)mg/L, (3.54±1.90)pg/L) were significantly higher than those in the NA-MDD group ((1.19±0.66)mmol/L, (0.933±0.89)mg/L, (2.65±1.34)pg/L) (t=2.254, 2.250, 2.352, all P<0.05). The incidence of cortisol disturbance was 72% in the A-MDD group, and 48% in the NA-MDD group, and the difference was statistically significant (χ2=5.369 P=0.020). Multivariate Logistic regression found that sleep disorder (β=0.729, OR=2.072, 95%CI=1.018-3.119), IL-6(β=0.583, OR=1.792, 95%CI=1.168-2.748), cognitive impairment (β=0.099, OR=1.104, 95%CI=1.022-1.193), cortisol rhythm disorders(β=0.075, OR=1.078, 95%CI=1.014-1.146)were the risk factors for anxious depression. Conclusion Anxious depression has a high incidence of cortisol rhythm disorder.The COR and IL-6 may be mediators of cortisol rhythm disorder.IL-6 and cortisol rhythm disorder together with sleep disorder and negative cognition constitute maybe high risk factors for anxious depression. Key words: Anxious depression; Cortisol rhythm; IL-6; Sleep disorder

Venlafaxine in the Treatment of Moderate and Severe Depression: Approaches to Increasing Treatment Efficacy

Objective. TO identify the factors influencing the efficacy of venlafaxine in moderate and severe depression. Materials and methods. An observational study was performed in the conditions of real clinical practice. A total of 62 patients with depression (21 men and 41 women, aged 19–61 years) treated with venlafaxine were studied. Treatment was continued for 84 days (initially in hospital and then in out-patient conditions). The initial venlafaxine dose was 75 mg/day and the mean therapeutic dose was 225 mg/day. Patients’ status was evaluated using a clinical psychopathological approach method and various scales – (MADRS, Beck scale, CGI, UKU). Results and conclusions. Study drug was found to display high efficacy in the treatment of severe and moderate depression. Venlafaxine was most effective in the treatment of anxious depression and least effective in hypochondriac depression. Use of rapidly increasing doses in the treatment of severe and moderate depression generated treatment responses in shorter periods of time without reducing the tolerance of the agent.

Dynamics of biochemical changes in anxious-depressed patients under treatment with antidepressants with different mechanisms of action on serotonin reuptake

ObjectivesPharmacodynamics of serotonergic antidepressants differently influencing on serotonin reuptake receptors is poorly investigated.AimTo compare biochemical profiles at patients with anxious depression under treatment with tianeptine–serotonin reuptake enhancer and sertraline–selective serotonin reuptake inhibitor.MethodsPlatelet monoamine oxidase (MAO) and serum amine oxidase (AO) activities, level of middle mass endotoxic molecules (MMEM) and serum albumin functional properties – effective albumin concentration (EAC) and reserve of albumin binding (RAB) were investigated at 43 patients with anxious depression (F 32.1 and F 33.1). Clinical severity of illness was assessed using Hamilton Depression (21 items) and Hamilton Anxiety Scales. All patients were divided in two groups: group I (21 person) received tianeptine (37, 5 mg/day), group II – sertraline (50 mg/day).ResultsIt was established that patients with anxious depression were characterized by significant increase in MAO activity (by 95%) and the level of MMEM (by 86%) and significant decrease in AO activity (by 28%) and EAC and RAB parameters by 43 and 38%, respectively, in comparison with healthy volunteers. Under tianeptine and sertraline treatment, there were revealed contrary directed changes of all investigated parameters.ConclusionResults of study show that both tianeptine and sertraline are equally effective in treatment of anxious depression. Present biochemical investigation, however, suggest that underlying biochemical changes are more complete following tianeptine treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Venlafaxine in the treatment of moderate and severe depressions: the ways to increase treatment efficacy

To find factors influencing the efficacy of venlafaxine in moderate and severe depressions. An observational study was carried out in real clinical practice. We examined 62 patients with depression, 21 men and 41 women, aged from 19 to 61 years, treated with venlafaxine. The duration of treatment was 84 days (first at the hospital and then at home). The initial dose was 75 mg daily, mean therapeutic dose 225 mg daily. Patient's status was assessed using clinical/psychological methods and psychometric scales (MADRS, Beck scale, CGI, UKU). The high efficacy of the drug in the treatment of severe and moderate depressions was demonstrated. Venlafaxine was mostly effective in the treatment of anxious depression and less effective for hypochondriac depression. The rapid increase in dose of venlafaxine makes it possible to reach treatment effect in shorter time without worsening drug tolerability.

Pharmacologic treatment of dimensional anxious depression: a review.

To review the pharmacologic treatment of dimensionally defined anxious depression. English-language, adult human research articles published between 1949 and February 2013 were identified via PUBMED and EMBASE. The search term was treatment of anxious depression. We identified and reviewed 304 original articles. Of these, 31 studies of patients with anxious depression, who were treated with an antidepressant or antipsychotic, are included in this review. All studies explicitly used a dimensional definition of anxious depression. All patients were treated with either antidepressants or antipsychotic medications. Of the 31 relevant psychopharmacologic studies identified, 7 examined patients receiving only 1 medication, 2 studied cotherapeutic strategies, 1 examined antipsychotic augmentation, and 21 compared multiple medications. Eleven were pooled analyses from several studies. All studies were of adults (18-92 years old). The Hamilton Depression Rating Scale Anxiety/Somatization Factor Score was used to define anxious depression in 71% of the studies, and 77.4% were post hoc analyses of previous datasets. Seventeen studies found selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and/or tricyclic antidepressants (TCAs) to be useful for successfully treating anxious depression. However, patients with anxious depression were less likely to experience sustained response or remission. Furthermore, baseline anxious depression puts patients at greater risk for side effect burden. Despite achieving response with SSRIs, SNRIs, and TCAs, patients with dimensionally defined anxious depression do not maintain response or remission and often report a larger burden of side effects compared to nonanxious depressive patients, suggesting that it is a harder-to-treat subtype of major depressive disorder.

Pregabalin in acute treatment of anxious depression: A case series

Symptoms of anxiety are common in patients with depression. In this retrospective case series we investigated the effect of Pregabalin as an add-on medication in unipolar depressed patients with high levels of anxiety. The therapeutic effect of Pregabalin showed a fast onset and was comparable to the anxiolytic effect of benzodiazepines.

Efficacy of Bupropion and the Selective Serotonin Reuptake Inhibitors in the Treatment of Major Depressive Disorder With High Levels of Anxiety (Anxious Depression)

The goal of this work was to compare the efficacy of the norepinephrine and dopamine reuptake inhibitor bupropion with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder with high levels of anxiety (anxious depression). Ten double-blind, randomized studies from 1991 through 2006 were combined (N = 2122). Anxious depression was defined as a 17-item Hamilton Rating Scale for Depression (HAM-D-17) anxiety-somatization factor score >or= 7. Among patients with anxious depression (N = 1275), response rates were greater following SSRI than bupropion treatment according to the HAM-D-17 (65.4% vs. 59.4%, p = .03) and the Hamilton Rating Scale for Anxiety (61.5% vs. 54.5%, p = .03). There was also a greater reduction in HAM-D-17 mean +/- SD scores (-14.1 +/- 7.6 vs. -13.2 +/- 7.9, p = .03) and a trend toward statistical significance for a greater reduction in HAM-A mean +/- SD scores (-10.5 +/- 7.4 vs. -9.6 +/- 7.6, p = .05) in favor of SSRI treatment among patients with anxious depression. There was no statistically significant difference in efficacy between bupropion and the SSRIs among patients with moderate/low levels of anxiety. There appears to be a modest advantage for the SSRIs compared to bupropion in the treatment of anxious depression (6% difference in response rates). Using the number-needed-to-treat (NNT) statistic as 1 indicator of clinical significance, nearly 17 patients would need to be treated with an SSRI than with bupropion in order to obtain 1 additional responder. This difference falls well above the limit of NNT = 10, which was suggested by the United Kingdom's National Institute of Clinical Excellence. Nevertheless, the present work is of theoretical interest because it provides preliminary evidence suggesting a central role for serotonin in the regulation of symptoms of negative affect such as anxiety.

Biochemical profile in patients with anxious depression under the treatment with serotonergic antidepressants with different mechanisms of action

The pharmacodynamics of serotonergic antidepressants that differentially influence serotonin reuptake transporters is poorly investigated. The aim of this study was to compare the biochemical profiles in patients with anxious depression under the treatment with tianeptine, a serotonin reuptake enhancer, and sertraline, a selective serotonin reuptake inhibitor. Platelet monoamine oxidase (MAO) and serum amine oxidase (AO) activities, concentration of middle-mass endotoxic molecules (MMEM) and parameters that characterize the functional properties of serum albumin were investigated in 43 patients with anxious depression (ICD-10: F 32.1 and F 33.1). It was established that, in comparison with healthy controls, patients with anxious depression were characterized by the significant increase in MAO activity (by 95%), MMEM concentration (by 86%), and a significant decrease in AO activity (by 43%) and also in functional albumin activity. The results of the study show that both tianeptine and sertraline are equally effective in the treatment of anxious depression. The present biochemical investigation, however, suggests that the underlying biochemical changes are more complete following tianeptine treatment.

Anxiety symptoms in elderly patients with depression: what is the best approach to treatment?

Depressed elderly persons frequently have concurrent symptoms of anxiety or comorbid anxiety disorders. Such comorbidity is associated with a more severe presentation of depressive illness, including greater suicidality. Additionally, most antidepressant treatment studies in the elderly have found poorer treatment outcomes in those with comorbid anxiety (including delayed or diminished response and increased likelihood of dropout from treatment). While antidepressants such as selective serotonin reuptake inhibitors and tricyclic agents are efficacious for late-life depression, there is no evidence that either class is superior, in terms of efficacy or tolerability, in the treatment of anxious depression. Rather, the amount and quality of clinical management, and not the particular medication chosen, appears to influence the likelihood of remission or treatment withdrawal in anxious depressed elderly patients. Co-prescription of benzodiazepines, typically lorazepam, is also warranted in some cases for severe anxiety or insomnia, but carries the risk of cognitive or motor impairment. It is our experience that close clinical monitoring, together with maximization of antidepressant treatment (by maximising dosage, augmenting or switching agents in cases of partial or no response, and/or adding psychotherapy) will almost always result in remission of depressive symptoms, together with improvement of anxiety, in these individuals. Therefore, optimism should be maintained when treating the depressed elderly individual, even when comorbid anxiety is present.