Treatment Of Depressive Disorder Research Articles

Case Report: Case report : Mindfulness training led to catharsis and mindfulness-to-meaning in a patient with social anxiety disorder comorbid with persistent depressive disorder (Dysthymia)

Background The use of mindfulness in the treatment of anxiety and depression is becoming more and more widespread, but there are few reports that it has fundamentally changed patients’ sense of life. Case Presentation This report showed 9 year’s progress of treatment for Social Anxiety Disorder and Persistent Depressive Disorder in a 41-year-old female patient experiencing a long-term painful married life with a reckless husband and controlling mother-in-law. During the past 25 months, she received 180 sessions of mindfulness training, resulting in complete remission of the anxiety and depression symptoms. After the 30th session she experienced an episode of the catharsis during the mindfulness training and experienced what can be called Mindfulness-To-Meaning, which is characterized by durable eudaimonic well-being in the face of adversity. Conclusions The psychological mechanisms that supported arriving at Mindfulness-To-Meaning are delineated as: Heightened (1) awareness which promoted (2) verbalization of the primary theme of suppression, in which the stress was (3) appraised metacognitively. Then (4) decentering permitted integrating this painful theme into a new adaptive self and world view, which resulted in (5) emotional catharsis, or release. Furthermore (6) positive appraisal of this experience enhanced awareness and led to the experience of (7) Mindfulness-To-Meaning.

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.

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.

Adverse psychiatric effects of psychedelic drugs: a systematic review of case reports.

Psychedelic drugs are a focus of interest in the treatment of depression and other disorders but there are longstanding concerns about possible adverse psychiatric consequences. Because the relevant literature is largely informal, the seriousness of these risks is difficult to evaluate. Searches were made for case reports of schizophrenia-spectrum, affective or other psychiatric disorders after use of psychedelic drugs. Case reports of flashbacks were also searched for. Individuals with recent use of other drugs (apart from cannabis and alcohol) and/or a previous history of major psychiatric disorder were excluded. Symptoms were tabulated using the Syndrome Check List of the Present State Examination (PSE-9). We found 17 case reports of schizophrenia spectrum disorder, 17 of affective disorder (depression, mania, or both), 3 cases of anxiety, 1 of depersonalization, and 1 of unclassifiable illness. The states could develop after a single use of the drug (5/17 schizophrenia; 6/17 affective disorder), and duration was highly variable. Recovery was the rule in cases of affective disorder but not in schizophrenia spectrum disorder. Twelve of 29 cases of flashbacks showed psychiatric symptomatology definitely outlasting the attacks, mainly anxiety (5 cases) and depression (8 cases). Flashback symptoms resolved within twelve months in approximately half of the cases but in a few persisted for years. Reliable descriptions of schizophrenia spectrum disorder and major affective disorder after psychedelic drug use disorder exist but are relatively uncommon. Flashbacks are sometimes but not always associated with psychiatric symptomatology, mainly anxiety or depression.

Mucuna pruriens, a Possible Treatment for Depressive Disorders.

Depression is a mental disorder that depicts a wide variety of symptoms, including mood and cognitive alterations, as well as recurrent thoughts of death or suicide. It could become the second leading cause of premature death or disability worldwide. Treatments with conventional antidepressants have several limitations in terms of effectiveness, side effects, and high costs. Therefore, medicinal plants such as Mucuna pruriens are potent candidates for treating depressive disorders. This review shows a compendium of evidence supporting the antidepressant effect of the Mucuna pruriens plant in diverse animal models. This includes the mechanisms of action underlying the antidepressant activity of the treatment concerning dopamine, serotonin, norepinephrine, reactive oxygen species, nitric oxide, cortisol, and inflammation. Clinical trials are needed to study the efficacy and safety of Mucuna pruriens for depression.

The relation between cerebral morphological abnormalities in major depressive disorder and antidepressant treatment

Abstract. The cerebral morphological abnormalities caused by Major Depressive Disorder (MDD) are markedly different from those of many other cerebral parts in non-patients. This brain disorder may be coordinated by antidepressant treatment. This paper investigates the links between antidepressant medication and morphological features in MDD using a literature review method. The paper finds that there is a positive response and feedback on these neurobiological alterations. The relationship between morphological features and treatment may make it easier to objectively observe the effects of antidepressants on MDD patients. The review emphasizes the importance of understanding the cerebral morphological changes associated with MDD, as well as how antidepressant therapy can potentially modulate these alterations. By exploring the relationship between pharmacological interventions and structural brain changes, the paper provides insights into the neurobiological mechanisms underlying the therapeutic effects of antidepressants. This knowledge can enhance the advancement of more focused and efficient therapy approaches for patients with Major Depressive Disorder.

Aperiodic (1/f) neural activity robustly tracks symptom severity changes in treatment-resistant depression.

A reliable physiological biomarker for Major Depressive Disorder is essential for developing and optimizing neuromodulatory treatment paradigms. This study investigates a passive electrophysiologic biomarker that tracks changes in depressive symptom severity on the order of minutes to hours. We analyze brief recordings from intracranial electrodes implanted deep in the brain during a clinical trial of deep brain stimulation for treatment-resistant depression in 5 human subjects (nfemale= 3, nmale = 2). This surgical setting allows for precise temporal and spatial sensitivity in the ventromedial prefrontal cortex, a challenging area to measure. We focused on the aperiodic slope of the power spectral density, a metric reflecting the balance of activity across all frequency bands and serving as a proxy for excitatory/inhibitory balance in the brain. Our findings demonstrate that shifts in aperiodic slope correlate with depression severity, with flatter (less negative) slopes indicating reduced depression severity. This significant correlation was observed in all N=5 subjects, particularly in the ventromedial prefrontal cortex. This biomarker offers a new way to track patient responses to Major Depressive Disorder treatment, paving the way for individualized therapies in both intracranial and non-invasive monitoring contexts.

Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review.

Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M.

Recent Progress in Synthetic and Natural Catechol-O-methyltransferase Inhibitors for Neurological Disorders.

Catechol-O-methyltransferase (COMT) inhibitors have played a crucial role in the development of potent and selective drugs for the treatment of Parkinson's disease, depression, and anxiety disorders. This review provides a comprehensive analysis of the structure-activity relationship (SAR) of COMT inhibitors, highlighting key structural features and pharmacophoric elements that govern their potency, selectivity, and pharmacokinetic properties. This review also discusses the application of SAR principles in the design and optimization of COMT inhibitors. Our analysis reveals the emergence of novel chemical scaffolds and the potential for COMT inhibitors to address unmet medical needs in neurology and psychiatry. This Perspective serves as a valuable resource for clinicians and researchers, providing insights into the rational design of COMT inhibitors and the development of next-generation therapeutics.

Spindles in WAG/Rij Rats with Absence Epilepsy and Comorbid Depression

WAG/Rij rats are a valid model of absence epilepsy and comorbid depression. We have previously shown that WAG/Rij rats have disturbances in the sleep-wake cycle and changes in the characteristics of sleep spindles. A negative correlation was also found between the number of spike-wave discharges (SWD) and the duration of rapid eye movement (REM) sleep. Clinical evidence suggests that the traditional antidepressants imipramine and fluoxetine are effective in suppressing symptoms of depression, but may have a negative impact on the sleep-wake cycle and comorbid epilepsy in patients. Our previous studies in WAG/Rij rats showed that imipramine, when administered chronically, increases the number of SWDs, while fluoxetine at the same dose reduces their number, although both antidepressants have a pronounced antidepressant effect. Comparison of the effects of the antidepressants imipramine and fluoxetine on the sleep-wake cycle and sleep spindles in WAG/Rij rats remains unstudied. The purpose of this work is to find out: 1) what effects do imipramine and fluoxetine have on the sleep-wake cycle and the characteristics of sleep spindles in WAG/Rij rats and 2) whether there are differences in their effects. To achieve this goal, the characteristics of the sleep-wake cycle and sleep spindles were compared in WAG/Rij rats after chronic administration of antidepressants and saline and in non-epileptic Wistar rats. Administration of imipramine led to a significant decrease in the duration of REM sleep. The administration of imipramine, compared with fluoxetine, also increased the latency of the transition to sleep and the transition to REM sleep. Sleep spindle amplitude was significantly increased by both antidepressants. However, the spectral power density of “slow” and “medium” spindles, which predominate in WAG/Rij rats compared to Wistar rats, was significantly higher after administration of imipramine than fluoxetine. The results suggest that imipramine causes greater negative changes in the sleep-wake cycle and sleep spindles than fluoxetine. Studies in the WAG/Rij rat model indicate that fluoxetine is more preferable antidepressant for the treatment of depressive disorders comorbid with absence epilepsy, since it does not cause a significant deterioration in sleep quality. These results are consistent with clinical data.

The impact of sleep disturbances on treatment efficacy and prognosis in patients with depressive and anxiety disorders.

Little was known about the relationship between sleep disturbances and depressive and anxiety disorders, as well as the efficacy of treatment regimens. During 2021 to 2023, a total of 417 participants were screened by Hamilton Depression Rating Scale (HAMD-17) and Hamilton Anxiety Rating Scale (HAMA-14) for psychological status, and Pittsburgh sleep quality index (PSQI) assessment. 409 participants were finally enrolled, of which 188 (45.97%) were suffered from sleep disorders. All participants were received polysomnography (PSG) followed by six-week pharmacological treatment of escitalopram and zopiclone, and finally assessed by HAMD-17 and HAMA-14 for treatment efficacy. PSG monitoring indicated that participants with depression experienced prolonged rapid eye movement sleep latency (REMSL) and increased wakefulness after sleep onset (WASO) (P=0.030 and P=0.002, respectively). Those with anxiety disorders demonstrated a significantly higher percentage of non-rapid eye movement sleep (NREM%) and reduced WASO (P=0.013 and P=0.001, respectively). After six-weeks pharmacological treatment, participants with or without sleep disorders exhibited with similar efficacy outcomes of depression and anxiety disorders (P>0.05). However, every point of PSQI increment at baseline would decrease 0.78 and 0.85 times of probability of effective pharmacological treatment of depression and anxiety disorders. Moreover, participants with both effective outcomes of depression and anxiety disorders were found significant shorter sleep onset latency (SOL) (P<0.001). The insights gained underscore the necessity of considering sleep disturbances in enhancing the overall effectiveness of pharmacological treatments for depression and anxiety disorders.

Use of Subsidized Health Services by Artists in Canada: An Exploratory Study.

Creative and performing artists are often confronted with precarious employment and insufficient healthcare coverage. A clinic in Canada that provides specialized healthcare to artists offers eligible artists subsidized health services. We aim to compare the use of health services, demographics and health conditions between subsidy artist recipients (SAs) and non-subsidy artists (NSAs). We accessed existing data from 265 SAs and 711 NSAs and applied descriptive and inferential statistics to address our research questions. Musculoskeletal issues, stress, anxiety disorders, and depressive disorders are the most common health problems faced by SAs. Compared to NSAs, SAs were more likely to seek treatment for stress, but less likely to seek treatment for anxiety disorders, depressive disorders, chronic problems, and upper extremity problems. Future research may investigate the enduring effects of subsidized health services on SAs' health outcomes. Sustained positive outcomes are crucial for maintaining an artist's career and well-being.

Integrated network pharmacology and transcriptomics to reveal the mechanism of Passiflora against depressive disorder: An observational study.

Relevant studies have pointed out that Passiflora could relieve depressive disorder (DD) related symptoms, such as anxiety and insomnia, but its mechanism in DD has not been reported. In this study, DD-related transcriptome data was extracted from the Gene Expression Omnibus (GEO) database. Subsequently, 50 differentially expressed genes (DEGs) were screened by "limma," and the enrichment analysis of these DEGs revealed that they were associated with neuro-inflammatory-related signaling pathways, including IL-17, TNF, NF-kappa B, etc signaling pathways. Then, CCDC58, CXCL5, EGR1, LOC101929855, SCML1, and THBS1 were screened as biomarkers of DD by the least absolute shrinkage and selection operator (LASSO) analysis. Moreover, Harmaline, Harmine, Quercetin, and Kaempferol were the key chemically active ingredients of Passiflora. Noticeable, THBS1 and Quercetin were connected closely. In addition, the quantitative real-time polymerase chain reaction (qRT-PCR) confirmed that the key biomarkers (EGR1 and THBS1) were significantly lowly expressed in DD samples. In summary, we identified 2 key biomarkers of DD and 4 key chemically active ingredients of Passiflora. The potential mechanism of antidepressant effect of DD associated with neuro-inflammatory responses and neurotransmitter function. These might related to the synergistic activity of its key active ingredients with TNF-α, IL-1β, IL-6, etc, which work with EGR1 and THBS1 to regulate IL-17, NF-kappa B, TNF, etc signaling pathways. These findings might help to deepen the understanding of the mechanism of Passiflora in clinical treatment of DD.

Research Progress on NMDA Receptor Enhancement Drugs for the Treatment of Depressive Disorder.

Major depressive disorder (MDD) is a severe mental illness with a complex etiology. Currently, many medications employed in clinical treatment exhibit limitations such as delayed onset of action and a high incidence of adverse reactions. Therefore, there is a pressing need to develop antidepressants that exhibit enhanced efficacy and safety. The N-methyl-D-aspartate receptor (NMDAR), a distinctive glutamate-gated ion channel receptor, has been implicated in the onset and progression of depressive disorder, as evidenced by both preclinical and clinical research. The NMDAR antagonist, ketamine, exhibits rapid and sustained antidepressant effects, holding promise as a novel therapeutic approach for depressive disorder. However, its psychotomimetic impact and potential for addiction have restricted its widespread clinical application. Notably, over the past decade, studies have suggested that enhancing NMDAR functionality can produce antidepressant effects with improved safety, especially with the emergence of NMDAR-positive allosteric modulators (PAMs). We view this as a potential novel strategy for treating depression, forming the basis for the narrative review that follows.

Meta-correlation of the effect of ketamine and psilocybin induced subjective effects on therapeutic outcome

There is some evidence that the subjective effects of ketamine and other psychedelics like psilocybin are crucial for their therapeutic outcomes, such as treatment of depression or substance use disorder (SUD). We performed a meta-analysis and systematic review on the correlation of subjective symptoms and dissociation versus ketamine-induced therapeutic outcomes in patients with depression or SUD. A similar analysis was conducted for psilocybin-induced therapeutic improvement. We retrieved 23 papers studying ketamine (21 on depression, 2 on SUD) in 471 patients and 8 papers studying psilocybin (6 on depression, 2 on SUD) in 183 patients. Our study demonstrated a modest role for subjective effects mediating therapeutic outcomes, with R2-values ranging from 5–10% for ketamine and for psilocybine the R2 was 24%. A greater mediating effect for psilocybin compared to ketamine was detected, particularly when restricting the analysis to depression. Additionally there is a greater mediating effect in SUD than depression, irrespective of treatment.

Bright Light Therapy for Nonseasonal Depressive Disorders

Seasonal humor disorders are prone to have a link with daylight exposure. However, the effect of external light on nonseasonal disorders remains unclear. Evidence is lacking for the validity of bright light therapy (BLT) as an adjunctive treatment for these patients. To assess BLT effectiveness as an adjunctive treatment for nonseasonal depressive disorders. In March 2024, a comprehensive search was performed of publications in the MEDLINE, Embase, and Cochrane databases for randomized clinical trials (RCTs) evaluating BLT effects in patients with nonseasonal depression. RCTs published since 2000 were eligible. Comparisons between BLT and dim red light or antidepressant monotherapy alone were considered for inclusion. Using the systematic review approach on RCTs published from January 1, 2000, through March 25, 2024, differences between patients treated with and without BLT were estimated using the Mantel-Haenszel method; heterogeneity was assessed using I2 statistics. Remission of symptoms, response to treatment rates, and depression scales were assessed. In this systematic review and meta-analysis of 11 unique trials with data from 858 patients (649 female [75.6%]), statistically significant better remission and response rates were found in the BLT group (remission: 40.7% vs 23.5%; odds ratio [OR], 2.42; 95% CI, 1.50-3.91; P <.001; I2 = 21%; response: 60.4% vs 38.6%; OR, 2.34; 95% CI, 1.46-3.75; P <.001; I2 = 41%). With BLT, subgroup analysis based on follow-up times also showed better remission (<4 weeks: 27.4% vs 9.2%; OR, 3.59; 95% CI, 1.45-8.88; P = .005; I2 = 0% and >4 weeks: 46.6% vs 29.1%; OR, 2.18; 95% CI, 1.19-4.00; P = .01; I2 = 47%) and response (<4 weeks: 55.6% vs 27.4%; OR, 3.65; 95% CI, 1.81-7.33; P <.001; I2 = 35% and >4 weeks: 63.0% vs 44.9%; OR, 1.79; 95% CI, 1.01-3.17; P = .04; I2 = 32%) rates. Results of this systematic review and meta-analysis reveal that BLT was an effective adjunctive treatment for nonseasonal depressive disorders. Additionally, results suggest that BLT may improve the response time to the initial treatment.

Problems of depression in neurological practice

Introduction. Depressive disorders have ceased to be only the task of psychiatrists. Depression is detected in patients with a somatic and neurological profile as a reaction to the disease, and may be the cause of the disease. The number of above-mentioned pathologies remains unknown to date. The main task for health care organizers is the need to build an algorithm for the identification, registration and treatment of depressive disorders in patients with combined pathologies. This article discusses depressive disorders in patients with multiple sclerosis. The purpose of the study: to study depressive disorders and factors influencing depression in patients with multiple sclerosis. Materials and methods. 203 patients with clinically confirmed diagnosis of MS participated. Taking into account the course of the disease, MS patients were distributed: with a remitting (RRS) type of MS course 88.2 % (179 people) and 11.8 % (24 people) with a secondary progressive course (RRS). The average age of the examined patients with remitting course (RRS) ranged from 15 to 63 years, on average 38 ± 10 years. The age of the examined patients with HPV is in the range from 29 to 65 years, on average (46 ± 9.00) years. The majority of patients had a disease duration of less than 20 years, on average 8.23±6.57 years. The average age of onset of the disease is 30.2±10.5 years. The duration of the disease is 9.84 ± 0.73 years, while the level of disability of patients (score in points on the Expanded Disability Status Scale/EDSS) at the time of examination was 2.89 ± 0.16 points. The disability index varied in patients with RRS2.89 ± 0.16 points, in patients with RRS (5.0 ± 0.24) points. Results and discussion. 55.7 % (113 people) of MS patients were diagnosed with depression, of which 80.5 % (91 people) and 19.5% (22 people) of patients with a remitting (RRS) course and a secondary progressive course of the disease (RRS). More than 54.8 % (62 people) had mild and moderate depressive manifestations, 39.8 % (45 people) most often had mixed anxiety-depressive disorder, recurrent depressive disorder, then depressive episodes. It was revealed that the development of depression in patients with a remitting course is influenced by: «disease duration» PC p = 0.00333**, «disability level» p = 0.0457* and «personal anxiety» p = 0.0194. In patients with a secondary progressive course, depression is influenced by the following factors: «situational» p = 0.0398* and «personal anxiety» p = 1.740. The social status determined that patients with «MS without depression» who were married were statistically less likely to suffer from depression and maintained their working capacity longer (p &lt; 0.001). Conclusion. Depressive disorders are the leading disorders in neurological patients, but their number and severity of symptoms are often ignored by specialists. Therefore, the health authorities are faced with the task of building a clinical and organizational algorithm for the identification of depressive disorders, as well as their timely medical correction.

Effectiveness of an Internet-Based Transdiagnostic Unified Protocol Intervention for the Treatment of Depressive and Anxiety Disorders in Women with Threatened Abortion: A Feasibility Study

Background: Despite the high prevalence of depressive and anxiety disorders among women with threatened abortion (TA), there is scant evidence regarding the efficacy of psychotherapies for this group. Objectives: This research aimed to assess the effectiveness, acceptability, and feasibility of specific internet-based cognitive behavioral therapy (iCBT-Specific) and unified protocol (iUP) for women with a TA. Methods: In this semi-experimental study (from April to October 2023), after the treatment content was prepared, a total of 80 pregnant women with TA, over 18 years of age, having a gestational age of 5 - 12 weeks, from a hospital and two private clinics, who were diagnosed with depressive and anxiety disorders based on the short structured diagnostic interview (Mini-International Neuropsychiatric Interview), were selected. The participants were divided into two groups, undergoing iUP or iCBT-specific psychotherapies. All participants completed the Brief Symptom Inventory (BSI-18) to measure the levels of depressive and anxiety symptoms. Following eight weeks of internet-based therapy, consisting of eight 50-minute sessions, they completed the BSI-18 again, along with the Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Statistical analysis was performed using SPSS version 22 software, and t-test, paired t-test, and ANCOVA tests were used. Results: Both the iUP and iCBT-Specific models demonstrated high acceptability, and the average feasibility of treatment was above average for both models. In terms of acceptability and feasibility of treatment for women with TA, neither model proved to be superior (all P &gt; 0.05). Both iUP and iCBT-Specific models were effective in reducing depression and anxiety in these women (effect size for within groups were respectively Eta = 0.370, Eta = 0.536). Also, in terms of improving depression and anxiety, there was no significant difference in the effectiveness of iUP and iCBT-Specific treatments (respectively P = 0.146, Eta = 0.027 and P = 0.221, Eta = 0.019) Conclusions: The iUP treatment can be recognized as a reliable alternative to the iCBT-Specific method for alleviating depressive and anxiety symptoms in women with TA. Also, our results help gynecologists to use iUP as an alternative treatment when there is no definitive diagnosis of the type of disorder.

In-vivo Pharmacokinetic Evaluation of Venlafaxine HCl Sustained Release Tablet Formulation.

An optimized Venlafaxine SR tablets formulation, was chosen for in‐vivo study against the commercial marketed Venlafaxine SR formulation. The non-compartmental pharmacokinetic specifications of both reference and standard were determined, after dosing via oral route. The peak plasma concentration (Cmax) of optimized Venlafaxine SR tablets was found as 964.66 ± 53.15ng/ml in 5 hr, while Cmax of marketed Venlafaxine SR tablets formulation was found as 872.33 ± 28.43 ng/ml in same time i.e. 5 hr. The Cmax data suggests that absorption of drug in plasma from was in sustained manner from both the formulations, showing typical absorption pattern of SR product. The AUC0-t for optimized and marketed Venlafaxine SR tablets was found to be 12981.63 ± 505.25 and 12023.83 ± 668.29 ng/ml*h, while AUC0-∞ was found to be 13921.51 ± 417.40 and 13099.63 ± 742.21 ng/ml*h, respectively. The PK parameter showed the Tmax and AUC for optimized Venlafaxine SR tablets as compared to its marketed product formulation. Pharmacokinetic parameter clearly suggested prolong release and availability of Venlafaxine in plasma from SR tablets formulation. Overall, the results suggest that the optimized SR formulation of Venlafaxine provides effective extended and controlled drug delivery, highlighting its potential clinical relevance in the treatment of depression and anxiety disorders.

Consensus-based recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy: A report from the Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy.

The Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy (ILAE) aimed to develop recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy. The Task Force conducted a systematic review and identified two studies that assessed the accuracy of four screening measures for depression and anxiety symptoms compared with a psychiatric interview. Nine studies met the eligibility criteria for treatment of anxiety and depressive disorders or symptoms. The risk of bias and certainty of evidence were assessed. The evidence generated by this review followed by consensus where evidence was missing generated 47 recommendations. Those with a high level of agreement (≥80%) are summarized. Diagnosis: (1) Universal screening for anxiety and depression is recommended. Closer surveillance is recommended for children after 12 years, at higher risk (e.g., suicide-related behavior), with subthreshold symptoms, and experiencing seizure worsening or therapeutic modifications. (2) Multiple sources of ascertainment and a formal screening are recommended. Clinical interviews are recommended whenever possible. The healthcare provider must always explain that symptom recognition is essential to optimize treatment outcomes and reduce morbidity. (3) Questioning about the relationship between symptoms of anxiety or depression with seizure worsening/control and behavioral adverse effects of antiseizure medications is recommended. Treatment: (1) An individualized treatment plan is recommended. (2) For mild depression, active monitoring must be considered. (3) Referral to a mental health care provider must be considered for moderate to severe depression and anxiety. (4) Clinical care pathways must be developed. (5) Psychosocial interventions must be tailored and age-appropriate. (6) Healthcare providers must monitor children with epilepsy who are prescribed antidepressants, considering symptoms and functioning that may not improve simultaneously. (7) Caregiver education is essential to ensure treatment adherence. (8) A shared-care model involving all healthcare providers is recommended for children and adolescents with epilepsy and mental health disorders. We identified clinical decisions in the management of depression and anxiety that lack solid evidence and provide consensus-based guidance to address the care of children and adolescents with epilepsy.