Bright light treatment as mono-therapy of non-seasonal depression for 28 adolescents.

BACKGROUND: Bright light therapy, an effective therapeutic option for depressive adults, could provide safe, economic, and effective rapid recovery also in adolescents. METHODS: Twenty-eight volunteers, between 14 and 17 years old and suffering from mild depressive disorder according to DSM-IV criteria, completed the study. This was a randomized cross-over trial, i.e. that 14 patients received first placebo (50 lux) for 1 h a day for 1 week and then bright light therapy (2,500 Lux) for 1 week. Fourteen patients received first bright light therapy and then placebo. For assessment of depressive symptoms, Beck's depression inventory scales were administered 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment. Saliva melatonin and cortisol samples were collected at 08:00 and 20:00 h, 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment and assayed for melatonin and cortisol to observe any change in circadian timing. RESULTS: BDI scores improved significantly. The assays of saliva showed significant differences between treatment and placebo. No significant adverse reactions were observed. CONCLUSION: Antidepressant response to bright light treatment in this age group was statistically superior to placebo.

Agomelatine treatment with adolescents with ADHD.

OBJECTIVE: Antidepressants, in particular Atomextine, along with stimulants have demonstrated benefit in the treatment of ADHD. Agomelatine is a new antidepressant with additional affinities to the melatonergic system. As ADHD has been associated with sleep disorders, it is assumed that Agomelatiine might serve as a therapeutic alternative to treat patients with the ADHD refractory to first line medications. METHOD: Ten late adolescents were evaluated in a placebo controlled manner. RESULTS: Agomelatine's effect was superior to that of placebo but appeared to be less than that of first line medications such as methylphenidate. CONCLUSION: Agomelatine may be a useful second line medication for individuals with ADHD, particularly if they suffer from additional sleep disorders.

Treating ADHD with agomelatine.

OBJECTIVE: Agomelatine is a relatively new antidepressant, with affinities to MT1 and MT2 (responsible for the circadian rhythm) as well as to 5-HT2C receptors. Since antidepressants have demonstrated some benefit in the treatment of ADH and because of the fact, that ADHD is often associated with sleep disorders, we assumed, that it might be a therapeutic alternative also for ADHD. METHOD: We proved this assumption in ten ADHD patients in a placebo controlled manner. RESULTS: Agomelatine's effect was superior to that of placebo, but seems to be less than that of Methylphenidate or placebo. CONCLUSION: If ADHD therapy with Methylphenidate or Atomoxetine is not indicated e.g. because of adverse side effects and if an ADHD patient suffers from additional sleep disorders, Agomelatine might be a helpful therapeutic alternative.

Additional biological therapies for attention-deficit hyperactivity disorder: repetitive transcranical magnetic stimulation of 1 Hz helps to reduce methylphenidate.

Excessive hyperactivity, impulsiveness and attentional difficulties characterize attention-deficit hyperactivity disorder (ADHD). The aim of this case report is to signal the possible therapeutic effectiveness of the repetitive transcranial magnetic stimulation (rTMS). Low frequency (1Hz, 1200 stim/die for five days) was applied on the impending scalp in the motor additional area of a patient suffering from combined type ADHD who received methylphenidate (MPH). We saw a significant improvement, especially according to criteria associated with hyperactivity. The improvement lasted for at least three weeks and suggested the final reduction in dosage of MPH.to 10 mg.

Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report.

OBJECTIVE: A possible association of celiac disease with psychiatric and psychological disturbances such as attention-deficit/hyperactivity disorder (ADHD) has been reported repeatedly. The objective of this study was to observe whether a gluten-free diet could alleviate the behavioral symptoms in patients with celiac disease and ADHD. METHOD: Sixty-seven subjects aged 7 to 42 years (mean = 11.4 years) with ADHD were enrolled in the study in South Tyrol, Italy, from 2004 to 2008. Hypescheme, an operational criteria checklist that incorporates DSM-IV and ICD-10 criteria, was used to assess ADHD-like symptomatology. Additionally, blood serum levels of all subjects were assessed for possible celiac disease by examining antigliadine and antiendomysium antibodies. A gluten-free diet was initiated for at least 6 months in celiac disease-positive patients with ADHD. RESULTS: Of the 67 patients with ADHD, 10 were positive for celiac disease. After initiation of the gluten-free diet, patients or their parents reported a significant improvement in their behavior and functioning compared to the period before celiac diagnosis and treatment, which was evident in the overall mean score on the Hypescheme questionnaire (t = 4.22, P = .023). CONCLUSIONS: Celiac disease is markedly overrepresented among patients presenting with ADHD. A gluten-free diet significantly improved ADHD symptoms in patients with celiac disease in this study. The results further suggest that celiac disease should be included in the ADHD symptom checklist.

Developing biochemical profiles for various psychiatric diseases.

It is well known, that most of the psychiatric diseases affect various neurotransmitter systems. It is the aim of this profile to define a set of cheap analyses, indicative for a specific psychiatric disease, to facilitate differential diagnosis and to offer an additional tool to the already existing clinical-descriptive methods.

Bright light treatment as add-on therapy for depression in 28 adolescents: a randomized trial.

BACKGROUND: In the last decade, a significant incidence of depression in the younger population has been observed. Bright light therapy, an effective therapeutic option for depressed adults, could also provide safe, economical, and effective rapid recovery in adolescents. METHOD: The randomized trial included 28 inpatients (18 females and 10 males) between 14 and 17 years old with depressive complaints. The study was conducted between February and December of 2010 in Rodewisch, Germany. Half of the patients (n = 14) first received placebo (50 lux) 1 hour a day in the morning from 9:00 am to 10:00 am for 1 week and then received bright light therapy (2,500 lux) for 1 week in the morning from 9:00 am to 10:00 am. The other half (n = 14) first received bright light therapy and then received placebo. Patients were encouraged to continue ongoing treatment (fluoxetine 20 mg/day and 2 sessions of psychotherapy/week) because there were no changes in medication/dosage and psychotherapy since 1 month before the 4-week study period. For assessment of depressive symptoms, the Beck Depression Inventory (BDI) was administered 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, and on the day after and 1 week after bright light treatment. Saliva samples of melatonin and cortisol were collected at 8:00 am and 8:00 pm 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, on the day after bright light treatment, and 1 week after bright light treatment and were assayed for melatonin and cortisol to observe any change in circadian timing. RESULTS: The BDI scores improved significantly (P = .015). The assays of saliva showed significant differences between treatment and placebo for evening melatonin (P = .040). No significant adverse reactions were observed. CONCLUSIONS: Antidepressant response to bright light treatment in this age group was statistically superior to placebo. TRIAL REGISTRATION: World Health Organization International Clinical Trials Registry Platform identifier: DRKS00003309.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.