Risky decision-making in major depressive disorder: A three-level meta-analysis / Toma de decisiones arriesgadas en el trastorno depresivo mayor: un metanálisis de tres niveles

Background: Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD. Method: We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed. Results: Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity. Conclusions: MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.(AU)

Aberrant positive affect dynamics in individuals with subthreshold depression: Evidence from laboratory and real-world assessments / Dinámica aberrante del afecto positivo en individuos con depresión subumbral: evidencia de evaluaciones de laboratorio y del mundo real

Background/Objective: Reduced positive affect (PA) is a core feature of major depressive disorder (MDD). However, the precursor of MDD, subthreshold depression (StD), has received less attention in this regard. Therefore, we examined PA dynamics in StD, integrating laboratory-based and ecological momentary assessment (EMA) approaches. Method: Participants were college students recruited from Chinese universities (31 with StD, and 39 healthy controls (HC)). Positive mood was induced in the laboratory by an eight-minute comedy clip used to assess PA reactivity and maintenance. To extend findings to the real world and explore mechanisms of PA maintenance, 53 participants with StD and 64 HC reported their emotional states 14 times daily for one week via EMA. Multilevel models were used to test for predictors of PA inertia. Results: In the laboratory, participants with StD achieved the same PA reactivity as HC when facing positive stimuli, yet the curve-fitting revealed difficulties for the StD group in maintaining PA over time. Such reduced capacity was further observed in real-world settings, manifesting in significantly greater PA inertia. Conclusions: High PA inertia in daily life may reflect resistance to mood change in StD, explaining anhedonia and difficulties with emotional maintenance, and highlighting the need for early identification.(AU)

Association of major depressive disorder (MDD) with zinc levels and handgrip muscle strength in a sample of Colombian adults / Asociación del trastorno depresivo mayor con los niveles séricos de zinc y la fuerza muscular

Introduction: Depression is related with poor musclestrength, and deficiencies of microelements such as Zinc (Zn).Otherwise, Zn is related with muscle strength, but there is noevidence of the relations between muscle strength and Znlevels in depression. Objective: To determine the association between serum Zn levels, handgrip muscle strength, and depression. Methods: An observational, analytical case-control study. 102 depressive patients hospitalized at the San Juan de DiosClinic in Manizales, and 36 controls with no personal historyof mental illness were evaluated for depression severity,serum Zn levels, and handgrip muscle strength. The groupswere matched by sex, age, educational level, and socioeco-nomic stratum. The severity of depression was assessed us-ing the Montgomery–Asberg Rating Scale (MADRS). Serum Znlevels were determined, and handgrip muscle strength wasassessed using dynamometer. Descriptive analysis, logistic reression and linear models were performed with depressionand severity of depression as dependent variables. Results: Lower Zn levels and reduced handgrip musclestrength were related to the presence of depression with thelogistic model. Lower handgrip muscle strength and severityof depression were associated with the linear model. Conclusion: An association was found between depressionand low Zn levels, and an inverse association between severityof depression and handgrip muscle strength. Future studiesshould investigate causality, and to evaluate the relationshipbetween depression, muscle strength and nutritional status.(AU)

Introducción: La depresión se encuentra relacionada con una disminución de la fuerza muscular y deficiencia de microelementos como el Zinc (Zn). De otra parte, el Zn está relacionado con la fuerza muscular, sin embargo, no hay evidencia si existe una asociación entre fuerza muscular y Zn en depresión. Objetivo: Determinar la asociación entre niveles séricos de Zn, fuerza muscular y depresión. Metodología: Se realizó un estudio observacional, analítico de casos y controles. Participaron 102 pacientes hospitalizados en la Clínica San Juan de Dios de Manizales y 36 controles sin historia personal de enfermedad mental. Fueron evaluados la severidad de la depresión, los niveles séricos de Zn y la fuerza de agarre manual. Los grupos fueron pareados por edad, sexo, escolaridad y estrato socioeconómico. La severidad de la depresión se evaluó con la escala de depresión Montgomery-Asberg (MADRS), se determinaron niveles séricos de Zn y la fuerza muscular fue evaluada con por dinamometría. Se realizo un análisis descriptivo, y modelos de regresión logística y regresión lineal con depresión y severidad de la depresión como variables dependientes.Resultados: El modelo de regresión logística encontró una asociación entre los niveles bajos de Zn y la fuerza muscular con la presencia de depresión. El modelo de regresión lineal encontró una relación entre menor fuerza de agarre y severidad de la depresión.Conclusión: Existe una asociación entre depresión y niveles bajos de Zn, y una relación inversamente proporcional entre severidad de la depresión y menor fuerza muscular. Estudios en el futuro deben investigar relaciones de causalidad y evaluar la relación entre depresión, fuerza muscular y estado nutricional.(AU)

Psychometric Properties of the Connor-Davidson Resilience Scale (CD-RISC) in Spanish Adolescents

Few studies have examined the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a large adolescent community sample, finding a significant disparity. This study explores the psychometric properties of the CD-RISC among Spanish adolescents by means of exploratory factor analysis (EFA), Rasch analysis, and measurement invariance (MI) across sex, as well as internal consistency and criterion validity. The sample was comprised of 463 adolescents (231 girls), aged 12 to 18 years, who completed the CD-RISC and other measures on emotional status and quality of life. The EFA suggested that the CD-RISC structure presented a unidimensional model. Consequently, shorter unidimensional CD-RISC models observed in the literature were explored. Thus, the Campbell-Sills and Stein CD–RISC–10 showed the soundest psychometric properties, providing an adequate item fit and supporting MI and non-differential item functioning across sex. Item difficulty levels were biased toward low levels of resilience. Some items showed malfunctioning in lower response categories. With regard to reliability, categorical omega was. 82. Strong associations with health-related quality of life, major depressive disorder symptoms, and emotional symptoms were observed. A weak association was found between resilience and the male sex. Campbell-Sills and Stein’s CD–RISC–10 model emerges as the best to assess resilience among Spanish adolescents, as already reported in adults. Thus, independently of the developmental stage, the core of resilience may reside in the aspects of hardiness and persistence. (AU)

Aprendizaje y memoria verbal: Comparación entre pacientes con trastorno por consumo de alcohol y trastorno de depresión mayor / Learning and verbal memory: A comparison between patients with alcohol use disorder and major depressive disorder

El daño cerebral relacionado con el consumo de alcohol se asocia a alteraciones de las funciones cognitivas, entre las que destacan memoria y aprendizaje verbal. El objetivo principal es evaluar memoria y aprendizaje verbal en una muestra de 111 pacientes con trastorno por consumo de alcohol (TCA) versus 78 con trastorno de depresión mayor (TDM) y 100 controles sanos. La evaluación incluyó variables sociodemográficas y clínicas, la Escala de Hamilton para la Depresión (HDRS) y el Test de Aprendizaje Verbal de California (CVLT). Se utilizó ANOVA de un factor para comparaciones entre los 3 grupos y ANCOVAS bidireccionales incluyendo diferentes covariables. El ANOVA de un factor muestra que los pacientes con TCA y TDM obtienen puntuaciones similares entre sí e inferiores a las del grupo control (p < 0,001), con excepción del CVLT Guiado (peores puntuaciones en TDM vs TCA, p < 0,001). Tras incluir como covariables la edad, sexo y los años de estudios completados, persisten las diferencias entre los grupos de TCA y TDM frente al grupo control (p ≤ 0,003) en todos los índices con excepción del CVLT Libre Inmediato y del CVLT Guiado (peor rendimiento en TDM vs TCA, p = 0,022 y p = 0,035, respectivamente). En el segundo ANCOVA, tras controlar por gravedad de la depresión, únicamente se detectan diferencias entre los pacientes con TCA y los controles sanos (p ≤ 0,007). Los pacientes con TCA presentan una importante alteración en aprendizaje y memoria verbal al compararlos con pacientes con TDM y con personas sanas. (AU)

Brain damage related to alcohol consumption is associated with impairments in cognitive functions, among which memory and verbal learning stand out. The main objective is to evaluate memory and verbal learning in a sample of 111 patients with alcohol use disorder (AUD) versus 78 with major depressive disorder (MDD) and 100 healthy controls. The evaluation included sociodemographic and clinical variables, the Hamilton Depression Scale (HDRS) and the California Verbal Learning Test (CVLT). One-way ANOVA was used for comparisons between the 3 groups and two-way ANCOVAS including different covariates. The one-way ANOVA shows that patients with AUD and MDD had scores similar to each other and lower than those of the control group (p <0.001), with the exception of the Cued CVLT (worse scores in MDD vs AUD, p <0.001). After including age, sex and years of completed studies as covariates, the differences between the AUD and MDD groups persisted compared to the control group (p ≤ 0.003) in all indices except for the Immediate Free CVLT and the Cued CVLT (worse performance in MDD vs AUD, p = 0.022 and p = 0.035, respectively). In the second ANCOVA, after controlling for depression severity, differences were only detected between AUD patients and healthy controls (p ≤ 0.007). Patients with AUD present a significant impairment in learning and verbal memory when compared with patients with MDD and with healthy people. (AU)

Síndrome de Cotard, más allá del delirio nihilista: a propósito de un caso / Cotard's syndrome, beyond the nihilistic delusion: About a case

El presente artículo pretende ampliar la información clínica y de neuroimagen del síndrome de Cotard, presentar el abordaje terapéutico, así como las limitaciones en su práctica. Se presenta el caso de una paciente de 54 años con antecedente de trastorno bipolar que ingresó a una institución de salud mental, con una clínica depresiva con tendencia a la clinofilia, acompañado por delirio nihilista y de culpa. Se inició el tratamiento farmacológico con antipsicóticos, antidepresivos y un estabilizador del ánimo con la consecuente resolución del cuadro y mejora en la calidad de vida. En la actualidad, queda mucho por conocer acerca de esta entidad clínica. La neuroimagen funcional y la clínica, serán los pilares que nos permitan dilucidar las complejidades fisiopatológicas y lograr avances en su clasificación, diagnóstico y manejo integral. (AU)

The present article aims to expand the clinical and neuroimaging information of Cotard Syndrome, present therapeutic approaches, as well as the limitations in its practice. The case of a 54-year-old patient with a history of bipolar disorder who was admitted to a mental health institution with a depressive clinical presentation characterized by clinophilia, accompanied by nihilistic and guilt delusions, is presented. Pharmacological treatment was initiated with antipsychotics, antidepressants, and a mood stabilizer, resulting in the resolution of the condition and an improvement in the quality of life. Currently, much remains to be known about this clinical entity. Functional neuroimaging and clinical assessment will be the pillars that allow us to elucidate the physiopathological complexities and make advances in its classification, diagnosis, and comprehensive management. (AU)

Network-level dynamics underlying a combined rTMS and psychotherapy treatment for major depressive disorder: An exploratory network analysis

Background: Despite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression, there is a limited understanding of the mechanisms of action and how potential treatment-related brain changes help to characterize treatment response. To address this gap in understanding we investigated the effects of an approach combining rTMS with simultaneous psychotherapy on global functional connectivity. Method: We compared task-related functional connectomes based on an idiographic goal priming task tied to emotional regulation acquired before and after simultaneous rTMS/psychotherapy treatment for patients with major depressive disorders and compared these changes to normative connectivity patterns from a set of healthy volunteers (HV) performing the same task. Results: At baseline, compared to HVs, patients demonstrated hyperconnectivity of the DMN, cerebellum and limbic system, and hypoconnectivity of the fronto-parietal dorsal-attention network and visual cortex. Simultaneous rTMS/psychotherapy helped to normalize these differences, which were reduced after treatment. This finding suggests that the rTMS/therapy treatment regularizes connectivity patterns in both hyperactive and hypoactive brain networks. Conclusions: These results help to link treatment to a comprehensive model of the neurocircuitry underlying depression and pave the way for future studies using network-guided principles to significantly improve rTMS efficacy for depression. (AU)

Impaired social learning in patients with major depressive disorder revealed by a reinforcement learning model

Background/objective: Patients with major depressive disorder (MDD) have altered learning rates for rewards and losses in non-social learning paradigms. However, it is not well understood whether the ability to learn from social interactions is altered in MDD patients. Using reinforcement learning during the repeated Trust Game (rTG), we investigated how MDD patients learn to trust newly-met partners in MDD patients. Method: Sixty-eight MDD patients and fifty-four controls each played as ‘investor’ and interacted with ten different partners. We manipulated both the level of trustworthiness by varying the chance of reciprocity (10, 30, 50, 70 and 90%) and reputation disclosure, where partners’ reputation was either pre-disclosed or hidden. Results: Our reinforcement learning model revealed that MDD patients had significantly higher learning rates for losses than the controls in both the reputation disclosure and non-disclosure condition. The difference was larger when reputation was not disclosed than disclosed. We observed no difference in learning rates for gains in either condition. Conclusions: Our findings highlight that abnormal learning for losses underlies the social learning process in MDD patients. This abnormality is higher when situational unpredictability is high versus low. Our findings provide novel insights into social rehabilitation of MDD. (AU)

Blinding integrity of dorsomedial prefrontal intermittent theta burst stimulation in depression

Background: The antidepressant effect of repetitive transcranial magnetic stimulation (rTMS) is partly placebo, making blinding integrity important. Blinding of high-frequency rTMS and intermittent theta burst stimulation (iTBS) has been reported as successful at study end. However, blinding integrity at study start is rarely reported. The aim of this study was to investigate blinding integrity during a treatment course of iTBS over the dorsomedial prefrontal cortex (DMPFC) in depression. Methods: Forty-nine patients with depression from a double-blind-designed randomized controlled trial (NCT02905604) were included. Patients received either active or sham iTBS over the DMPFC with a placebo coil. The sham group received iTBS-synchronized transcutaneous electrical nerve stimulation. Results: After one session, 74% of participants were able to correctly guess their treatment allocation. This was above chance level (p = 0.001). The percentage dropped to 64% and 56% after the fifth and last sessions. Belonging to the active group influenced the choice to guess “active” (odds ratio: 11.7, 95% CI 2.5–53.7). A higher treatment intensity of the sham treatment increased the probability to guess “active”, but pain did not influence the choice. Conclusions: Blinding integrity in iTBS trials must be investigated at study start to avoid uncontrolled confounding. Better sham methods are needed. (AU)

Childhood trauma is linked to abnormal static-dynamic brain topology in adolescents with major depressive disorder

Childhood trauma is a leading risk factor for adolescents developing major depressive disorder (MDD); however, the underlying neuroimaging mechanisms remain unclear. This study aimed to investigate the association among childhood trauma, MDD and brain dysfunctions by combining static and dynamic brain network models. We recruited 46 first-episode drug-naïve adolescent MDD patients with childhood trauma (MDD-CT), 53 MDD patients without childhood trauma (MDD-nCT), and 90 healthy controls (HCs) for resting-state functional magnetic resonance imaging (fMRI) scans; all participants were aged 13–18 years. Compared to the HCs and MDD-nCT groups, the MDD-CT group exhibited significantly higher global and local efficiency in static brain networks and significantly higher temporal correlation coefficients in dynamic brain network models at the whole-brain level, and altered the local efficiency of default mode network (DMN) and temporal correlation coefficients of DMN, salience (SAN), and attention (ATN) networks at the local perspective. Correlation analysis indicated that altered brain network features and clinical symptoms, childhood trauma, and particularly emotional neglect were highly correlated in adolescents with MDD. This study may provide new evidence for the dysconnectivity hypothesis regarding the associations between childhood trauma and MDD in adolescents from the perspectives of both static and dynamic brain topology. (AU)

Prevalence and risk factors of anxiety symptoms in first-episode and drug-naïve major depressive disorder patients with metabolic syndrome

Background and objectives Patients with major depressive disorder (MDD) have high comorbidity with metabolic syndrome (MetS), although anxiety is prevalent comorbidity in MDD patients. However, there is no study on anxiety symptoms (AS) in MDD patients with MetS. Therefore, we aimed to identify the prevalence and risk factors of AS in patients with MetS who experienced a first-episode and drug naïve (FEDN) of MDD. Methods In this cross-sectional study, 1718 FEDN of MDD outpatients with MetS were included. Sociodemographic data, clinical characteristics, suicidal attempts, and physical and biochemical parameters were collected. Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Positive and Negative Syndrome Scale (PANSS) positive subscale were performed to detect the AS. Multiple linear regression analysis was used to analyze the correlation. Results The prevalence of AS in MDD patients with MetS was 85.96%, which was 1.79 times greater than that in patients with MDD alone (P<0.05). MDD patients with MetS had a greater rate of attempted suicide, a higher HAMD total score, and a higher diastolic blood pressure than MDD patients without AS (P<0.05). Their combination could distinguish AS in MDD patients. Moreover, HAMD score, thyroid-stimulating hormone (TSH) levels, PANSS positive score, and suicide attempts were related to HAMA scores in MDD patients with comorbid MetS (P<0.05). Conclusion There is a significant frequency of AS in MDD patients with MetS. Multiple clinical indicators and metabolic markers are associated with AS in patients with MDD and MetS. (AU)

Adherencia al tratamiento, aceptabilidad y tolerabilidad de venlafaxina XR a dosis de 300 mg/día en pacientes con trastorno depresivo mayor / Adherence, acceptability and tolerability of venlafaxine extended release at dose of 300 mg/ day in patients with major depressive disorder

Introducción. La adherencia a los antidepresivos es fundamental para obtener buenos resultados en el tratamiento de la depresión. El objetivo del actual estudio fue evaluar la adherencia, aceptabilidad y tolerabilidad de venlafaxina XR a dosis de 300 mg/día, administrada en uno o dos comprimidos, tras un periodo de tratamiento de 6 ± 2 meses en pacientes con trastorno depresivo mayor (TDM). Metodología. Estudio observacional, transversal, de práctica clínica habitual en el que participaron 590 pacientes con TDM que asistían a consultas de centros públicos o privados de toda España, de los cuales 361 y 229 recibieron uno (300 mg) o dos comprimidos (150+150 mg o 225+75 mg) de venlafaxina XR, respectivamente. Los datos del estudio se obtuvieron de la entrevista con el paciente, de la historia clínica y de cuestionarios validados. Resultados. El método Haynes-Sackett y el cuestionario de Morisky-Green revelaron que la adherencia al tratamiento fue similar en ambos grupos. Los pacientes que recibieron la dosis de venlafaxina XR en un comprimido mostraron mayor satisfacción con el tratamiento según el cuestionario TSQM9. La escala MADRS reveló que en el 23% de los pacientes el TDM había remitido, y solo en el 9% se mantenía grave, en el 26% era moderado y en el 42% leve. Igual resultado se obtuvo con el cuestionario PHQ-9. En general, los pacientes mostraron buena tolerabilidad a la venlafaxina XR a dosis altas con las dos pautas de administración, y los efectos adversos más comunes fueron la disfunción sexual, sudoración y estreñimiento. Conclusiones. La adherencia al tratamiento con venlafaxina XR de 300 mg/día en uno o dos comprimidos fue similar. Los pacientes que recibieron un solo comprimido mostraron mayor satisfacción con el tratamiento. El perfil de seguridad de venlafaxina XR 300 mg fue favorable. No se produjeron abandonos, ni elevaciones clínicamente significativas de la presión arterial que condicionaran la pauta de uso. (AU)

Background. Adherence to antidepressants is essential for good outcomes when treating depressive disorders. The objective of the current study was to evaluate the adherence, acceptability and tolerability of venlafaxine XR at a dose of 300 mg/day, administered in one or two tablets, after a treatment period of 6 ± 2 months in patients with major depressive disorder (MDD). Subjects and methods. Observational, cross-sectional study of routine clinical practice in 590 outpatients with MDD who attended at public or private centers all over country, of whom 361 and 229 received one (300 mg) or two tablets (150+150 mg o 225+75 mg) of venlafaxine XR, respectively. The study data were obtained from the interview with the patient, the clinical history and validated questionnaires. Results. The Haynes-Sackett method and the MoriskyGreen questionnaire revealed that adherence to treatment was similar in both groups. The patients who received the dose of venlafaxine XR in one tablet showed greater satisfaction with the treatment according to the TSQM-9 questionnaire. The MADRS scale revealed that in 23% of the patients the MDD had remitted, and only in 9% it remained severe, in 26% it was moderate and in 42% mild. The same result was obtained with the PHQ-9 questionnaire. In general, the patients showed good tolerability to high doses of venlafaxine XR with both dosing regimens, and the most common adverse effects were sexual dysfunction, sweating and constipation. Conclusions. Adherence to treatment with venlafaxine XR 300 mg/day in one or two tablets was similar. Patients who received a single tablet showed greater satisfaction with the treatment. The safety profile of high dose venlafaxine was favorable and there was dropouts or clinically significant elevations that affected the dosing regimen. (AU)

Non-pharmacological treatment-related changes of molecular biomarkers in major depressive disorder: A systematic review and meta-analysis

Background: Major depressive disorder (MDD) is a serious mood disorder and leading cause of disability. Despite treatment advances, approximately 30% of individuals with MDD do not achieve adequate clinical response. Better understanding the biological mechanism(s) underlying clinical response to specific psychopharmacological interventions may help fine tune treatments in order to further modulate their underlying mechanisms of action. However, little is known regarding the effect of non-pharmacological treatments (NPTs) on candidate molecular biomarker levels in MDD. This review aims to identify molecular biomarkers that may elucidate NPT response for MDD. Methods: We performed a systematic review and a multilevel linear mixed-effects meta-analyses, and a meta-regression. Searches were performed in PubMed, Scopus, and PsycINFO in October 2020 and July 2021. Results: From 1387 retrieved articles, 17 and six studies were included in the systematic review and meta-analyses, respectively. Although there was little consensus associating molecular biomarker levels with symptomology and/or treatment response, brain metabolites accessed via molecular biomarker-focused neuroimaging techniques may provide promising information on whether an individual with MDD would respond positively to NPTs. Furthermore, non-invasive brain stimulation interventions significantly increased the expression of neurotrophic factors (NTFs) compared to sham/placebo, regardless of add-on pharmacological treatment. Conclusions: NTFs are candidate biomarkers to fine-tune NIBS for MDD treatment. (AU)

Parental Psychopathology: An Exploratory Study of Parenting and Behavioral Problems among Adolescents

Mental health problems are reflected in the family and parent–child interactions disrupting the quality of caregiving and consequently resulting in adverse emotional behavioral child outcomes. Despite the incredible work on parent–child interactions and emotional behavioral outcomes in children of parents with psychopathology in Western countries, there is an extreme scarcity in Pakistan for empirical support in this area of research. Hence the present study is designed to fill this gap. The current study is an effort to empirically explore the parenting and behavioral problems among a sample of adolescents having parents with psychopathology (Major Depressive Disorder & Schizophrenia) and without psychopathology. For this purpose, 348 parents participated in the study with their adolescent children divided into two groups: Parents who suffered from Psychopathology and those who did not suffer from any kind of Psychopathology. Twin cities of Islamabad and Rawalpindi (Pakistan) were selected to approach the participants. Alabama Parenting Questionnaire (APQ) and Youth Self Report (YSR) were used to collect the data. The findings of the study revealed that parents with psychopathology reported less positive involvement/parenting and more negative/ineffective discipline as well as deficient monitoring. Likewise, their children (adolescents) scored higher on internalizing and externalizing behavioral problems as compared to those whose parents did not suffer from any psychopathology. Despite limitations, the results of current study are promising and significantly contribute to the existing literature. Implications have been discussed for planning the appropriate interventional strategies and specialized services for the affected children and their familiest (AU)

Relationship between the expression level of miRNA-4485 and the severity of depressive symptoms in major depressive disorder patients

Background and objectives: Despite the growing pieces of evidence on the relationship between the altered expression level of miRNAs and major depressive disorder (MDD), few studies have focused on the relationship between the altered expression of miRNAs and the severity of depressive symptoms. This study aimed to investigate the relationship between the expression level of miRNA-4485 and the severity of depressive symptoms in major depressive disorder (MDD) patients.MethodsEighty MDD patients without antidepressants and 45 healthy controls were placed and tested for the expression level of miRNA-4485 using quantitative RT‒PCR. At the same time, the Hamilton Depression Scale (HAMD) was used to assess depression symptoms for MDD patients. Twenty-nine out of 80 MDD patients were selected for miRNA expression level testing and symptomatology assessments before and after three weeks of treatment.ResultsThe expression level of miRNA-4485 in the MDD group was significantly overexpressed compared to that in healthy controls (P < 0.05), and the expression level of miRNA-4485 in the higher HAMD group was also much higher than that in the lower HAMD group and healthy controls (P < 0.05). The expression level of miRNA-4485 in MDD patients was negatively correlated with HAMD total score, anxiety/somatization, and bodyweight factor score (P < 0.05), accounting for 9.4%, 12.4% and 5.7%, respectively. MiRNA-4485 significantly predicted MDD and the severity of depressive symptoms (P < 0.05). Compared with that before treatment, the expression level of miRNA-4485 was significantly downregulated after treatment, while the patient's depressive symptoms were improved (p < 0.05). The improvement in depressive symptoms was positively correlated with the downregulation of miRNA-4485, which could significantly predict the effects of antidepressant treatment on MDD (P < 0.05). (AU)

¿Vulnerabilidad cognitiva a la depresión o sobreestimación de los síntomas disfóricos premenstruales? / Cognitive vulnerability to depression or overestimation of premenstrual dysphoric symptoms?

Es difícil estimar la verdadera presencia del trastorno disfórico premenstrual (TDPM). Las expectativas de las mujeres influyen en los síntomas del TDPM, lo que podría aumentar su vulnerabilidad a la depresión. Este estudio pretendió estimar la presencia de TDPM en un grupo de mujeres comparando su autodiagnóstico con la evaluación clínica; diferenciar los síntomas y su intensidad entre TDPM y su forma subsindrómica, así como determinar sus consecuencias sociolaborales y relacionales. Se analizan las diferencias entre TDPM y trastorno depresivo mayor (TDM) identificando una posible vulnerabilidad cognitiva a la depresión. En un diseño ex-post facto, participaron 105 mujeres, 85 de la población general (Medad= 23,60; DT 3,05) y 20 mujeres con TDM, (Medad= 25,15; DT 3,51). Para el autodiagnóstico, completaron varios autoinformes y los indicadores de criterios TDPM A, B, C (APA) y D (por autor). El diagnóstico clínico se realizó mediante entrevista semiestructurada siguiendo los criterios del DSM-5. El TDPM se sobreestimó cuando fue autoinformado (51,76%) contrastando con la evaluación clínica (5,88%). La vulnerabilidad cognitiva a la depresión para el TDPM no fue apoyada. (AU)

True premenstrual dysphoric disorder (PMDD) is hard to diagnose. It has been suggested that women’s expectations influence the symptoms of this disorder, which could increase their vulnerability to depression. This study aimed to estimate PMDD in a group of women by comparing their self-diagnosis with clinical evaluation; differentiate between PMDD symptoms and their intensity and its subthreshold form, determining its social-employment and relational consequences, finding differences in symptoms and vulnerability to depression; and identifying possible cognitive vulnerability to depression in PMDD. 105 women participated, 85 from the general population and 20 women with Major Depressive Disorder were selected. For the self-diagnosis, they filled out several self-reports and PMDD Criteria Indicators A, B, C (APA) and D (by author). The clinical diagnosis was made using a semi-structured interview following DSM-5 criteria. PMDD was overestimated when it was self-reported (51,76%) compared to clinical evaluation (5,88%). Therefore, retrospective and self-reported evaluation could bias what they remember and overestimate the indicators of the disorder and their severity. Cognitive vulnerability to depression for PMDD was not supported. (AU)

Radiografía de la detección y el tratamiento del trastorno depresivo en el sistema de salud público español: una revisión crítica / Detection and treatment of depressive disorder in the spanish health system: a critical review

La atención sanitaria de la depresión constituye unreto de primer nivel. El objetivo de esta revisión es plasmarel estado de la detección, diagnóstico y tratamiento de ladepresión en el sistema de salud público español. Se hananalizado los datos de la última Encuesta Nacional de Salud(ENSE 2017) y se ha realizado una búsqueda no sistemáticade publicaciones en las bases de datos PubMed y Scopus.Destacamos la alta especificidad y la baja sensibilidad en ladetección de casos de depresión mayor por parte de los médicos de Atención Primaria (AP) en España. La detección dela depresión es superior en la Atención Especializada que enAP. Se revisan los nuevos sistemas asistenciales basados en elabordaje compartido y en el modelo jerárquico de cribado,diagnóstico y derivación, y planteamos propuestas de mejoraa partir de diversos programas y modelos de atención sanitaria de la depresión. (AU)

Health care for depression is a major challenge. The aim ofthis review is to capture the status of the detection, diagnosis and treatment of depression in the Spanish public healthsystem. The data from the latest National Health Survey (ENSE2017) have been analyzed and a non-systematic search forpublications has been carried out in the PubMed and Scopusdatabases. We highlight the high specificity and low sensitivityin the detection of cases of major depression by Primary Care(PC) physicians in Spain. The detection of depression is superior in specialized care compared to PC. The new healthcaresystems based on the shared approach and the hierarchicalmodel of screening, diagnosis and referral are reviewed andwe present improvement proposals based on various programsand models of healthcare for depression (AU)

A systematic review of the characteristics of adolescents with major depressive disorder in randomised controlled treatment trials

Background and Objectives. Concerns exist around the generalizability of randomised controlled trials (RCTs) for adolescents with major depressive disorder (MDD). This review assesses whether adolescents with MDD treated in RCTs are representative of clinical samples. Methods. A systematic narrative review of selection criteria used in RCTs for adolescent MDD (PROSPERO CRD42018096298). Included were studies assessing psychological, pharmacological or combination treatments. Results. 52 studies were included. Overall, the reporting of selection criteria (defined as both inclusion and exclusion criteria), in the 23 psychotherapy trials was low (52% did not report on comorbid emotional disorders and 48% did not report on suicidal ideation). In contrast, the majority of selection criteria were reported in the 22 medication trials and the 7 combination trials. Where selection criteria were reported, most adolescents with comorbidities were excluded from psychotherapy and medication trials. The 7 combination trials included more adolescents with comorbidities. Of note, only 10 of the 52 studies reported on self-harm as a selection criteria. Conclusion. Reporting of the characteristics of depressed adolescents was poor in psychotherapy trials. Both psychotherapy and medication trials excluded many adolescents with co-morbid conditions, however combination trials tended to be more inclusive. There is concern that many RCTs for adolescent MDD may not be generalizable to clinical populations, particularly with regards to comorbidity, self-harm and suicidal ideation. The findings suggest that clinicians need to view the evidence base and guidelines developed from RCTs with discernment. Pragmatic trials are needed with representative clinical populations and comprehensive reporting of the selection criteria.

La calidad de vida relacionada con la salud en el trastorno depresivo mayor: factores asociados con su evolución / Health-related quality of life in major depressive disorder: factors associated with its evolution

Introducción. La Depresión Mayor (DM) es el trastorno de salud mental más prevalente. Se pretende analizar el peso de los factores asociados a la percepción de la Calidad de Vida Relacionada con la Salud (CVRS) en pacientes con diagnóstico de DM y su evolución durante seis meses. Metodología. Se incluyeron 432 sujetos con DM (DSMIV-TR) de consultas hospitalarias, centros de salud mental y centros de atención primaria en País Vasco, Madrid y Canarias. Se siguió a los pacientes durante 6 meses. Se recogieron variables clínicas, sociodemográficas y de abordaje terapéutico. La CVRS se midió mediante el EQ-5D-5L, expresado como “utilidades”. Se construyeron Modelos Lineales Generalizados para responder los objetivos. Resultados. Las mujeres, las personas de mayor edad, los grupos sociales menos favorecidos y aquellos con mayor comorbilidad “orgánica” expresaron una peor CVRS inicial. A los 6 meses permanecían en seguimiento 305 sujetos. El cambio medio en las “utilidades” fue de 0,033 (IC95%: 0,008-0,059), y de 0,132 (IC95%: 0,093-0,171) en los 109 sujetos (35,51%) que expresaron mejoría en su estado de salud. Se asociaron negativamente con la evolución de la CVRS la comorbilidad “orgánica”, la presencia de trastornos de la conducta alimentaria, una mayor edad, el pertenecer a grupos socioeconómicos desfavorecidos o la necesidad de un mayor esfuerzo terapéutico. Conclusiones. La DM se asocia con un gran impacto en la CVRS, que revierte parcialmente en el grupo con buena evolución clínica. La mayor edad, la comorbilidad y el grupo socioeconómico se asocian a una peor evolución de la CVRS.(AU)

Introduction. Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months. Methods. We included 432 subjects with MDD (DSM-IVTR) from hospital consultations, mental health centres and primary care centres in Basque Country, Madrid and Canary Islands. Patients were followed for 6 months. Clinical, sociodemographic and therapeutic variables were collected. HRQoL was measured by EQ-5D-5L, expressed as “utilities”. Generalized Linear Models were constructed to meet the objectives. Results. Women, older people, disadvantaged social groups and those with higher “physical comorbidity” expressed a worse HRQoL at inclusion. At 6 months, 305 subjects remained in follow-up. The average change in “utilities” was 0.033 (CI95%: 0.008-0.059), and 0.132 (CI95%: 0.093-0.171) in the 109 subjects (35.51%) who expressed improvement in their health status. “Physical comorbidity”, the presence of eating disorders, older age, belonging to disadvantaged socioeconomic groups or the need for greater therapeutic effort were negatively associated with HRQoL evolution. Conclusion. MDD is associated with a great impact on HRQoL, which partially reverts when the patients showed good clinical evolution. Older age, comorbidity and disadvantaged socioeconomic group are associated with a worse evolution of HRQOoL.(AU)