Treatment Of Depression In Patients Research Articles

Red yeast rice as an adjunct to sertraline for treatment of depression in patients with percutaneous coronary intervention: Placebo-controlled trial

ObjectivesRed yeast rice (RYR) has demonstrated neuroprotective effects in animal studies. The aim of this study was to access the efficacy of RYR for treatment of depression in patients with recent history of percutaneous coronary intervention. DesignThis was a 6-week double-blind placebo-controlled randomized clinical trial. SettingParticipants included outpatient men and women aged 18 to 60 years old with history of coronary angioplasty, diagnosis of major depressive disorder based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and Hamilton Depression Rating Scale (HDRS) score of ≥20. Candidates were excluded in case of any other DSM-V disorders, use of lipid lowering agents in the last two weeks, elevated serum aminotransferases or serum LDL≤80mg/dL. InterventionsPatients received sertraline (200mg/day) plus either red yeast rice commercially available capsules (2400mg/day) containing 10.05mg/day lovastatin or placebo. Main outcome measuresThe primary outcome was the difference in mean change of the HDRS score from baseline to endpoint between the two treatment arms. ResultsThe primary outcome approached significance (Mean difference in score change(CI95%)=−1.24 (−2.51 to 0.03), p=.056) and was accompanied by a significant time × treatment interaction effect [Two-way ANOVA: F (df, mean square)=4.42 (2, 13.687), p=.015]. There was no significant difference between the two treatment arms in terms of lipid profile, liver function tests, or incidence of adverse events. ConclusionsThis is the first report on the benefits of RYR in treatment of depression. Future studies are warranted to confirm our findings and scrutinize the mechanisms of action.

Treatment of depression in patients with breast cancer: a critical review.

To summarize current knowledge on psychopharmacological and psychotherapeutic options for patients with breast cancer and comorbid depression, starting from the psychiatric viewpoint. Issues on diagnostic boundaries of depression and outcome measures are raised. We completed a literature review from the last 30 years (until March 2012) using PubMed by pairing the key words: 'breast cancer and depression treatment' (about 1431 works, including 207 reviews), 'breast cancer and antidepressants' (about 305 works, including 66 reviews), and in particular 'selective serotonin reuptake inhibitors and breast cancer' (38 works, including 10 reviews) and 'breast cancer and psychotherapy' (603 works, including 84 reviews). Papers in the English language were selected, including recent reviews. There is little evidence for the superiority of any one specific intervention with pharmacological options or psychotherapy. The heterogeneity of assessment criteria, the small number of subjects collected in systematic studies, the difficulty in adopting standardized outcome measures, and the limited numbers of available drugs with a favorable side effect profile are the main limitations that emerge from the literature. No conclusive findings are available on mid-term/long-term treatment strategies, or when depression is part of a bipolar disorder. Further research is necessary to define the most appropriate approach to depression when it occurs in comorbidity with breast cancer. A more accurate definition of the clinical phenotypes of depression in the special population of patients with breast cancer is suggested as a key issue.

Health-Related Quality of Life, Depression, and Smoking Status in Patients with COPD: Results from the Behavioral Risk Factor Surveillance System Data

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality. People living with COPD often have a common triad of problems including decreased health-related quality of life (HRQL), smoking, and depression. Identifying barriers to preventing and treating COPD is of the utmost importance. The purpose of this study is to examine the relationship between HRQL, depression, and smoking status for patients with COPD. Methods: The 2016 BRFSS data was used to perform a cross sectional analysis of adult patients with a diagnosis of COPD. A comprehensive descriptive analysis of all study variables for those participants having COPD was performed. Then relationships between general HRQL, depression, and smoking status were examined. Data were analyzed using SPSS. Results: The original 2016 BRFSS dataset contained responses from 486,303 participants. After selecting participants who self-identified as having a diagnosis of COPD, 40,682 individual participants remained in the dataset for further analysis. The participants with COPD were mostly female, over the age of 65, with low-incomes, attended a year of college or less, with some type of healthcare coverage. Patients with a dual diagnosis of COPD and depression have poorer HRQL and an increased number of cigarettes smoked compared to those patients with COPD. Likewise, there is a significant relationship between HRQL and smoking status for patients with a dual diagnosis of COPD and depression. Conclusion: Depression as a comorbidity does have a statistically significant relationship with patients HRQL and smoking status. Future research should be aimed at increasing screening and treatment for depression in patients with COPD who continue to smoke. Further research on the cyclical relationship between COPD, depression, and smoking cessation would be beneficial.

Effectiveness of high-frequency repetitive transcranial magnetic stimulation in patients with depression and Parkinson's disease: a meta-analysis of randomized, controlled clinical trials.

AimThis meta-analysis aimed to assess the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for the treatment of depression in patients with Parkinson’s disease (PD).MethodsThe design was a meta-analysis of randomized controlled trials (RCTs). The participants were patients with PD who suffered from depression. The interventions were HF-rTMS alone or in combination with other treatments compared with sham-rTMS, placebo, and anti-depressant treatments. The primary outcome measure was changes in depressive symptoms, defined as the mean change in the total depression score. The secondary outcome was changes in motor symptoms, defined by Unified Parkinson’s Disease Rating Scale part III scores, and the acceptability, defined as the risk of all-cause discontinuation. These were expressed as mean differences (MDs), standardized mean differences (SMDs), or risk ratios (RRs) with 95% confidence intervals (CIs).ResultsWe identified nine suitable trials, with data from 332 participants. For the patients with depression in PD, HF-rTMS was not better than sham-rTMS (SMD =−0.33, 95% CI −0.83 to 0.17) or selective serotonin re-uptake inhibitors (SSRIs) (SMD =0.07, 95% CI −0.52 to 0.18) for the treatment of depressive symptoms. However, the motor benefits after treatment with HF-rTMS might be better than sham-rTMS (MD =−2.80, 95% CI −5.45 to −0.15) and SSRIs (MD =−2.70, 95% CI −4.51 to −0.90).ConclusionThis meta-analysis provides some evidence that in patients with PD with depression, HF-rTMS may lead to improvement in motor function but not in depression compared with sham-rTMS or SSRIs.

Factors associated with depression in patients with Parkinson's disease A multicenter study in Lima, Peru.

The diagnosis and treatment of depression in patients with Parkinson’s disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD.Objective:To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD.Methods:This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA.Results:Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms.Conclusion:Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment.

The effects of using the PReDicT Test to guide the antidepressant treatment of depressed patients: study protocol for a randomised controlled trial

BackgroundAntidepressant medication is commonly used to treat depression. However, many patients do not respond to the first medication prescribed and improvements in symptoms are generally only detectable by clinicians 4–6 weeks after the medication has been initiated. As a result, there is often a long delay between the decision to initiate an antidepressant medication and the identification of an effective treatment regimen.Previous work has demonstrated that antidepressant medications alter subtle measures of affective cognition in depressed patients, such as the appraisal of facial expression. Furthermore, these cognitive effects of antidepressants are apparent early in the course of treatment and can also predict later clinical response. This trial will assess whether an electronic test of affective cognition and symptoms (the Predicting Response to Depression Treatment Test; PReDicT Test) can be used to guide antidepressant treatment in depressed patients and, therefore, hasten treatment response compared to a control group of patients treated as usual.Methods/designThe study is a randomised, two-arm, multi-centre, open-label, clinical investigation of a medical device, the PReDicT Test. It will be conducted in five European countries (UK, France, Spain, Germany and the Netherlands) in depressed patients who are commencing antidepressant medication. Patients will be randomised to treatment guided by the PReDicT Test (PReDicT arm) or to Treatment as Usual (TaU arm). Patients in the TaU arm will be treated as per current standard guidelines in their particular country. Patients in the PReDicT arm will complete the PReDicT Test after 1 (and if necessary, 2) weeks of treatment. If the test indicates non-response to the treatment, physicians will be advised to immediately alter the patient’s antidepressant therapy by dose escalation or switching to another compound. The primary outcome of the study is the proportion of patients showing a clinical response (defined as 50% or greater decrease in baseline scores of depression measured using the Quick Inventory of Depressive Symptoms – Self-Rated questionnaire) at week 8. Health economic and acceptability data will also be collected and analysed.DiscussionThis trial will test the clinical efficacy, cost-effectiveness and acceptability of using the novel PReDicT Test to guide antidepressant treatment selection in depressed patients.Trial registrationClinicalTrials.gov, ID: NCT02790970. Registered on 30 March 2016.

Post-marketing observational program of the effectiveness of fluvoxamine for the treatment of depression in patients with neurological disorders: the FRIENDS study.

In a prospective, non-blinded, uncontrolled, multicenter, post-marketing, observational study (FRIENDS; NCT02043197), fluvoxamine (50–300 mg/day for 90 days) was effective for the treatment of depression in 299 adult patients (age ≥18 years) with neurological disorders at baseline. The therapeutic effect of fluvoxamine was measured by means of changes in the Hospital Anxiety and Depression Scale depression and anxiety scores (HADS-D and HADS-A, respectively), global severity of illness, and clinical condition (measured using the Clinical Global Improvement [CGI] scale). The mean HADS-D subscale score at baseline in the per-protocol cohort (n=296) was 11.7±3.1 points and the corresponding mean HADS-A score was 12.6±3.2. Significant (P<0.0001) improvements in both scores were recorded during fluvoxamine treatment and later follow-up. Most patients (>85%) recorded reductions versus baseline in both indices. In the CGI-based assessment, most evaluated patients (>200) experienced moderate to very substantial clinical improvement, with no or limited side effects. Significant improvements were also recorded in the exploratory outcomes of sleep quality, assessed using the Insomnia Severity Index, and cognitive function, assessed using the Montreal Cognitive Assessment (P<0.0001 vs baseline for both). No death or serious adverse drug reactions were reported during the study. The results of this observational study affirm that fluvoxamine is effective and well tolerated for the treatment of depression in the context of neurological disorders. The effects on the exploratory endpoints of this research merit evaluation in controlled trials.

The association of β-arrestin2 polymorphisms with response to antidepressant treatment in depressed patients

The study of genetic polymorphisms involved in antidepressants (AD) response is essential to provide a personalized medicine approach in the field of depression. β-arrestin 2 (ARRB2) is a candidate gene in the pharmacogenetics of AD as it is involved in the signaling cascade downstream of numerous neurotransmitter receptors. We investigated the association between five ARRB2 single nucleotide polymorphisms (SNPs): rs1045280, rs2036657, rs4790694, rs3786047 and rs452246, and response to AD treatment in a sample of 569 patients with a major depressive episode treated for 6months. We show that GG/GT patients for rs4522461 (n=534) and AA/AC patients for rs4790694 (n=244) have a lower response to AD than other genotype groups (HDRS score of 10.9 vs 8.0 after 6months, multivariate analysis: p=0.03; 12.2 vs 9.6, p=0.02, respectively). These data provide additional evidence that β-arrestin 2 is a regulator of intracellular signal transduction processes involved in AD treatment.

Psychoanalytic inpatient psychotherapy of depression – Two naturalistic samples throughout the course of a decade

Background: While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients.Method : This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge.Results: The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD).Conclusion: Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects.

A Randomized Controlled Trial of Right Low Frequency rTMS Combined with Escitalopram in Treatment of Patients with First-episode Depression in General Hospitals

Objective: To explore the clinical efficacy of right low frequency repetitive transcranial magnetic stimulation (rTMS) therapy combined with escitalopram in treating outpatients with first-episode depression. Methods: Seventy-eight patients with depressive disorder of ICD-10 criteria were recruited for the trial. All subjects were randomly divided into the active rTMS group (receive active rTMS) and sham group (receive sham rTMS). Each group received low frequency active or sham rTMS combined with 10 mg escitalopram per day. Patients in the active rTMS group were treated with active rTMS for continuous two weeks, while the sham patients were treated with pseudo stimulation. HAMD, HAMA and TESS were used to assess the efficacy and side effects before the treatment and at the ends of the second week and the fourth week of treatment, respectively. Results: 1) At the end of 4 weeks’ treatment, patients in the active rTMS group had a response rate of 87.8 % while the patients in the sham group had 41.5 %; 2) patients in the active rTMS group showed a significant efficacy at the end of 2 weeks, which was significantly different from the patients in the sham group; 3) Patients in the active rTMS group got a significantly lower score in HAMA at the end of 2 weeks, and there was a significant difference from the sham group; 4) There was only a local pain response. Conclusion: The right low-frequency rTMS technique combined with escitalopram in treatment of depressive patients in general hospitals has a significant better effect than mono-pharmacotherapy and can shorten the time of treatment.

P.2.b.014 - Agomelatine in the treatment of depressed patients with comorbid physical disorders

P.2.b.014 - Agomelatine in the treatment of depressed patients with comorbid physical disorders

P.2.h.002 - Increase of plasma levels of VEGF-D, but not VEGF-A and VEGF-C, after antidepressant treatment in depressed patients

P.2.h.002 - Increase of plasma levels of VEGF-D, but not VEGF-A and VEGF-C, after antidepressant treatment in depressed patients

Suicidal ideation declines with improvement in the subjective symptoms of major depression

BackgroundSuicidal ideation appears to be more strongly associated with subjective rather than neurovegetative symptoms of depression. Effective treatment, then, should produce reductions in suicidal ideation to the degree that these subjective symptoms are alleviated relative to treatment effects on other symptoms. MethodsIn a randomized clinical trial comparing paroxetine and bupropion for treatment of depression in patients with either suicidal ideation or past attempt, depression severity and suicidal ideation were assessed weekly during the 8-week study. Depression rating scales - the 24-item Hamilton Depression Rating Scale [HDRS] and the Beck Depression Scale [BDI] - were decomposed into symptom clusters based on our published factor analyses, and their change over time compared to changes on the Beck Scale for Suicidal Ideation [SSI]. ResultsImprovement in factor scores associated with subjective symptoms of depression - HDRS Psychic Depression, BDI Subjective Depression, and BDI Self-Blame - were the best predictors of declining scores on the SSI regardless of type of drug treatment. BDI Subjective Depression was the best single predictor in the context of all other significant univariate predictors, accounting for 31.4% of the variance in the change in SSI. The three factors together accounted for 35.3%. LimitationsThis is a secondary analysis of clinical trial data, with fixed treatments. ConclusionsEffective treatments to reduce suicidal ideation are associated with the reduction of the subjective symptoms of depression, which may not always decline in synchrony with improvement in neurovegetative symptoms. This asynchrony may result in a period of elevated risk after the initiation of therapy. Data indicate that subjective depression symptoms should be a primary target in the treatment of depressed suicidal patients.

Experience in the Use of Valdoxan (agomelatine) in the Treatment of Depression in Patients with Dyscirculatory Encephalopathy

Objective – to study the efficacy and tolerance of agomelatine (Valdoxan) in mild depressive states in patients with chronic cerebral ischemia (CCI). Materials and methods. The study included 33 patients (23 women, 10 men, mean age 54.5 years). Grade I CCI was diagnosed in 12 patients (36.4%) and grade II in 21 (63.6%). All patients had single depressive episodes of mild severity. Diagnoses of affective and cognitive impairments were based on the Hamilton Rating Scale for Depression (HRDS-17), the Hospital Anxiety and Depression Scale (HADS), the Vein Nocturnal Sleep Questionnaire, the Mini Mental State Examination (MMSE), the Mini-Cog test, the Montreal Cognitive Assessment Scale, the physician’s Clinical Global Impression scale for assessment of the severity and dynamics of illness (CGI-S, CGI-I), and the Patients’ Global Impression of Change Scale (PGIC). Investigations were performed at prescription of agent and at 2, 4, and 8 weeks of treatment. All patients received agomelatine (Valdoxan) once daily at a dose of 25 mg. Results and conclusions. Use of agomelatine led to improvements in sleep from week 2, with reductions in anxiety symptoms at six weeks, and reductions in depressive symptomatology at eight weeks of treatment. In addition, treatment with agomelatine produced improvements in cognitive functions in the patients. No patient experienced any treatment side effects. The study results demonstrated high antidepressant activity in the treatment of mild depressive disorders in patients with CCI, with a balanced spectrum of actions in relation to symptoms of anxiety, depression, and dyssomnia, along with positive actions on cognitive functions, allowing the use of agomelatine in the treatment of patients with CCI to be recommended.

Accelerated iTBS treatment in depressed patients differentially modulates reward system activity based on anhedonia

Objectives: Accelerated intermittent theta-burst stimulation (aiTBS) anti-depressive working mechanisms are still unclear. Because aiTBS may work through modulating the reward system and the level of anhedonia may influence this modulation, we investigated the effect of aiTBS on reward responsiveness in high and low anhedonic MDD patients.Methods: In this registered RCT (NCT01832805), 50 MDD patients were randomised to a sham-controlled cross-over aiTBS treatment protocol over the left dorsolateral prefrontal cortex (DLPFC). Patients performed a probabilistic learning task in fMRI before and after each week of stimulation.Results: Task performance analyses did not show any significant effects of aiTBS on reward responsiveness, nor differences between both groups of MDD patients. However, at baseline, low anhedonic patients displayed higher neural activity in the caudate and putamen. After the first week of aiTBS treatment, in low anhedonic patients we found a decreased neural activity within the reward system, in contrast to an increased activity observed in high anhedonic patients. No changes were observed in reward related neural regions after the first week of sham stimulation.Conclusions: Although both MDD groups showed no differences in task performance, our brain imaging findings suggest that left DLPFC aiTBS treatment modulates the reward system differently according to anhedonia severity.

The Diagnosis and Treatment of Behavioral Disorders in Dementia.

Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia." Behavioral disorders regularly accompany dementing illness and have identifiable and treatable somatic and environment-related causes. They should be treated symptomatically, both with non-pharmacological measures and with drugs. Memory therapy (d = 0.47), ergotherapy (d = 0.72), music therapy (d = 0.62), and physical exercise (d = 0.68) are effective, as are antidementia drugs (galantamine: p = 0.04, donepezil: p = 0.01, rivastigmine: p = 0.02, memantine: p = 0.004). Risperidone is the drug of choice to combat agitation and aggressiveness (d = 0.33) as well as dementia and hallucinations (d = 0.5). Citalopram can be recommended for the treatment of depression in patients with dementia (p = 0.05). Because of an improved evidence base, the latest version of the German S3 guideline on the diagnosis and treatment of dementia places greater emphasis on non-pharmacological treatments for behavioral disorders in dementia than it did in the past. The global efficacy of such treatments against behavioral disorders is well documented. Nonetheless, because of the heterogeneity of interventions and varying standards of assessment, the evidence for the utility of certain specific methods in the treatment of specific behavioral disorders is still limited. More research is needed in this area.

The role of thrombocyte serotonin system and some thrombocyte characteristics in treatment of depressive patients with cardiovascular diseases

IntroductionAmong the known neurotransmitters, serotonin, norepinephrine and dopamine play the important roles in the development of psychiatric disturbances. The research so far has shown that this is not the matter of concentrations themselves, but of disbalance of concentrations between the neurotransmitter systems in CNS (central nervous system). There is proof that there is a decrease of serotonin, epinephrine and dopamine functions in patients suffering from the recurring depressive episodes, while there is a hyperactivity of norepinephrine and dopamine system in patients suffering from the bipolar affective disorder [1]. There is still a dilemma if there were a hypo or hyperactivity of serotonin system in generalized anxiety disorder [2,3]. The agonists of 5HT1A receptors reduce the symptoms of panic disorders, while the activation of 5HT2C receptors induces a panic attack [4]. Hypersensitivity of postsynaptic serotonin receptors plays an important role in obsessive-compulsive disorders [5]. Destabilization of serotonin system has been noted also in posttraumatic stress disorders. This fact had been confirmed by the efficiency of SIPPS in its treatment [6]. Dysfunction of serotonin system is also present in some personality disorders, urge-control disturbances, feeding disorders and dementia. It seems that the negative symptoms in schizophrenia are due to a dysfunction of serotonin system. In suicidal tendencies, the role of serotonin system is of the greatest importance and numerous post-mortem investigations had revealed lower concentrations of serotonin and its main metabolite 5-hydroxyindolacetate acid (5-HIAA) in brainstem, nuclei raphe, putamen and hypothalamus [7]. Some research show that lower levels of thrombocyte serotonin are connected with suicidal behaviour of depressive patients [8]. Numerous investigations have shown that, among the patients who had suffered a myocardial infarction or other diseases of cardiovascular system we can find depressive symptoms in the frame of depressive reaction, but also a real depression in its fully-blown clinical form. Depression slows the recovery in those patients but, even more importantly, some indices had been found in patients suffering from depression that it could be directly connected with an increased risk for the development of cardiovascular diseases and complications during recovery. Thrombocyte serotonin is a strong vasoconstrictor and the research has shown that the treatment with selective inhibitors of serotonin uptake (SIPPS) causes lowering of its concentration, thus reducing its role in increasing the cardiovascular risk and causing the complications of recovery. Also, the treatment of depressive patients with SIPPS lowers the values of MPV (mean platelet volume, mean thrombocyte cell volume), which had been recognized as an independent risk factor for the development of myocardial infarction and stroke.Serotonin system in thrombocytesEnterochromafine cells are the only cells besides 5HT neurons, that synthetize serotonin. They release it into the blood stream, from where it, bound to its transporter, goes mostly into the thrombocytes. Serotonin system in thrombocytes is very similar to the one in neurons. It is a part of the mechanism of thrombocyte response, which is actually a process of shape change and aggregation of thrombocytes [9,10]. Thrombocytes contain about 99% of total serotonin in circulation, so in physiological conditions, plasma levels of serotonin reflect the concentration of serotonin in thrombocytes. Human throm- bocytes contain averagely 150 to 600 ng of serotonin/109 thrombocytes [11]. Serotonin system of thrombocytes is made of: serotonin transmembrane carrier ( transporter), serotonin receptor, enzyme monoaminooxidase and serotonin stored in delta granules. Serotonin enters the thrombocytes and aggregates through actions of two carriers [12]. Protein 5-HT carrier (5HTt) is located at the membrane of thrombocyte and enables the intake of serotonin and other endogenous amines, for example dopamine, from plasma to the cytoplasmic fluid of thrombocytes [13]. …

Management of Depression in Parkinson's Disease: A Systematic Review.

Depression is a frequent psychiatric condition in Parkinson's disease (PD). The treatment of depression has been examined in several randomized controlled trials and meta-analyses, but no clear guidelines are available. We carried out a systematic review of pharmacological and non-pharmacological treatments for depression in patients with PD using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched main medical databases up to December 12, 2016, and included randomized controlled trials, patient-control studies, and case series with data on treatment modality, outcome measures, and side effects. Selective serotonergic reuptake inhibitors and tricyclic antidepressants may have efficacy for the treatment of depression in patients with PD, although the evidence is not strong. The antidepressant efficacy of dopamine agonists is still controversial, and initial results were positive for pramipexole but not for rotigotine. Cognitive-behavioral therapy showed promising results in two recent randomized controlled trials, but further evidence is required. Studies using repetitive transcranial magnetic stimulation produced conflicting results, and the efficacy results for this treatment have been inconsistent. On the other hand, electroconclusive therapy produced strong positive results in patients with severe depression, but no randomized controlled trials are available. Selective serotonergic reuptake inhibitors and cognitive-behavioral therapy are currently first-line treatments for depression in patients with PD, although the evidence is still weak. The heterogeneity among contributory factors for depression in PD should be considered for the most effective treatment of depression in this condition.

Assessment of dietary habits and nutritional status of depressive patients, depending on place of residence.

An increased incidence of depressive disorders observed in recent years in the Polish and world population is a serious health problem. The aim of the study was to compare dietary habits and nutritional status of patients with recurrent depressive disorders, depending on their place of residence. Their impact on selected metabolic parameters was also considered. The study group comprised 96 women and 84 men reporting to the Outpatient Mental Health Clinic at the Department of Psychiatry, Medical University of Bialystok in north-eastern Poland. The average age of the women was 46.7±11.7 years, and of men 47.0±11.3 years. In the quantitative assessmentof diets, 24-hour food recall interviews were conducted. Assessment of the nutritional status of the respondents consisted of anthropometric measurements, body composition analysis and biochemical parameters. It was show that the diets of female urban inhabitants were characterized by a significantly lower energy value and total fat content, compared to their rural counterparts. The food rations of men living in the city had a significantly higher energy value, protein content and total FAT, compared to rural residents. It was also noted that urban residents of both genders were characterized by a lower percentage of body fat, both visceral and subcutaneous (women), and a higher water content than rural residents. The study showed dietary errors in all compared groups, regardless of place of residence, which was reflected in the nutritional status of the respondents. The results also indicated that during the declared change in dietary habits, the treatment of depressive patients should include dietary instructions in order to ensure an optimum supply of nutrients.

Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction

Background: Depression among patients with acute myocardial infarction (AMI) is prevalent and associated with an adverse quality of life and prognosis. Despite recommendations from some national organizations to screen for depression, it is unclear whether treatment of depression in patients with AMI is associated with better outcomes. We aimed to determine whether the prognosis of patients with treated versus untreated depression differs. Methods: The TRIUMPH study (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) is an observational multicenter cohort study that enrolled 4062 patients aged ≥18 years with AMI between April 11, 2005, and December 31, 2008, from 24 US hospitals. Research coordinators administered the Patient Health Questionnaire-9 (PHQ-9) during the index AMI admission. Depression was defined by a PHQ-9 score of ≥10. Depression was categorized as treated if there was documentation of a discharge diagnosis, medication prescribed for depression, or referral for counseling, and as untreated if none of these 3 criteria was documented in the medical records despite a PHQ score ≥10. One-year mortality was compared between patients with AMI having: (1) no depression (PHQ-9&lt;10; reference); (2) treated depression; and (3) untreated depression adjusting for demographics, AMI severity, and clinical factors. Results: Overall, 759 (18.7%) patients met PHQ-9 criteria for depression and 231 (30.4%) were treated. In comparison with 3303 patients without depression, the 231 patients with treated depression had 1-year mortality rates that were not different (6.1% versus 6.7%; adjusted hazard ratio, 1.12; 95% confidence interval, 0.63–1.99). In contrast, the 528 patients with untreated depression had higher 1-year mortality in comparison with patients without depression (10.8% versus 6.1%; adjusted hazard ratio, 1.91; 95% confidence interval, 1.39–2.62). Conclusions: Although depression in patients with AMI is associated with increased long-term mortality, this association may be confined to patients with untreated depression.