Screening and treatment of depression - recommendations for Polish health professionals.

INTRODUCTION: Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. Depressive disorders occur at all ages, in men and women, in different cultures, affecting individuals, their families, and, more broadly, the social and economic system of the country. The gap between the recorded number of treated patients and the prevalence of depression highlights the scale of unmet needs. With limited availability of specialists in psychiatric care, the most appropriate measures seem to be those aimed at increasing the competence of other health professionals in the diagnosis and treatment of depression. MATERIAL AND METHODS: An overview of the literature and available recommendations for the prevention, screening, and treatment of depression was performed. This work was commissioned by the Polish Ministry of Health under the Depression Prevention Program 2016-2020. RESULTS: Based on the literature review, we compiled the recommendations for Polish health professionals. These recommendations focus on the management of depression in the primary care setting and provide guidelines for health professionals other than psychiatrists concerning the prevention, screening, and treatment of depression. CONCLUSIONS: We developed a clear recommendation for non-psychiatrists concerning the screening, treatment, and further management of patients with depression. Early detection of depression and implementation of treatment improves the outcomes and prognosis and reduces the mortality rate.

Symptomatic differences and symptoms stability in unipolar and bipolar depression. Medical charts review in 99 inpatients. / Obraz psychopatologiczny i powtarzalnosc wystepowania objawów w chorobie afektywnej jednobiegunowej i chorobie afektywnej dwubiegunowej. Analiza dokumentacji 99 pacjentów.

OBJECTIVES: Misdiagnosis of bipolar disorder may result in a non-optimal treatment, higher servicecosts and increase in the patient's suffering and risk of suicidal behavior. Lack of clinically approved and suitable for widely use biomarkers of BD led clinicians to focus on clinical course and symptomatology of depression in BD. The aim of this study was the retrospective evaluation of symptomatic differences and symptoms stability between MDD and BD patients during three subsequent depressive episodes in the inpatient setting. METHODS: Retrospective chart review of 99 patients with diagnosis of MDD and BD during three subsequent depressive episodes. Chi-squared test and logistic regression was used to analyze the symptomatic profile. Cohen's kappa value used to estimate symptoms stability. RESULTS: Statistical differences were observed in the case of 7 out of 22 depressive symptoms. Somatization (pain and non-pain complains), psychomotor agitation and pathological guilt were more frequent in MDD patients. Anhedonia, attention deficit, and suicidal ideation were more frequent in BD group. In MDD group relatively highest symptom stability was observed for somatization, middle insomnia, early wakening, and attention deficit. In BD group relatively highest symptom stability was observed for delusions, somatization (pain and non-pain complains), initial and middle insomnia, memory disturbance, psychomotor retardation, and pathological guilt. CONCLUSIONS: The observed symptomatic differences may be an additional factor of MDD/DB differential diagnosis. Lower than previously reported symptoms stability highlights the need to evaluate more than one depressive episode in differential diagnosis.

The effect of vitamin D3 deficiency on the severity of depressive symptoms. Overview of current research. / Wplyw niedoboru witaminy D3 na poziom nasilenia objawów depresyjnych. Przeglad aktualnych badan.

Traditional methods of depression treatment with the use of pharmacotherapy with antidepressants have limited effectiveness. Biological, psychological and environmental causes of depressive disorders are known, but pathophysiology of depression has not been fully explained. Many factors and mechanisms play role in the pathophysiology of depression, one of which may be vitamin D3 deficiency. Deficiency or border level of vitamin D3 is fairly common in the general population and may occur even in one billion people globally. Epidemiological studies show that vitamin D3 or its metabolites do not reach an optimal level in most adults. Even lower than the optimal level may cause clinical symptoms and be one of the risk factors for depression. In the population of patients suffering from depressive disorders deficiency or insufficiency of vitamin D3 occur more frequently than in the general population. The use of vitamin D3in patients with depression may have antidepressant effect. Continuous supplementation may also reduce the risk of recurrence. This article is a review of literature on the possible impact of vitamin D3 deficiency on the prevalence of depression and antidepressant effect of the supplementation. Selection of articles was made by searching the Medline and PubMed databases using specific keywords: depression, vitamin D3 deficiency. Previous studies on the use of vitamin D3 and its role in prevention and treatment of depressive disorders included too small number of people to clearly assess the effectiveness and safety of supplementation used as adjunctive therapy to antidepressants, as well as and dose range which should be used.

Othello syndrome after STN DBS - psychiatric side-effects of DBS and methods of dealing with them. / Objawy zespolu Otella po wszczepieniu stymulatora jadra niskowzgórzowego - psychiatryczne dzialania niepozadane DBS i metody postepowania w ich przypadku.

OBJECTIVES: Deep brain stimulation is a therapeutic method used for decades in neurological diseases such as Parkinson's disease or dystonia. Despite many publications concerning DBS, there are few publications on psychotic symptoms after DBS, there are also no standards of dealing with them. METHODS: The authors present a case of a patient with Parkinson's disease, in whom psychotic symptoms in the form of Othello-like syndrome appeared after implantation of a stimulator. In this case the strategy of continuation of stimulation and adding antipsychotic drug (quetiapine) was chosen. RESULTS: Gradual resolution of psychotic symptoms, without worsening of neurological symptoms and no recurrence of psychiatric symptoms was observed. CONCLUSIONS: In recent years, work is underway on the use of DBS in psychiatry, particularly in patients with treatment-resistant depression. It is necessary to set the strategy for dealing with side-effects of DBS. Most of the authors prefer the temporary or permanent switch off the stimulator. In the author's opinion, in some cases it is possible to effectively treat the psychotic symptoms without resignation from the benefits of stimulation. So far, however, such cases were described so rarely that it is difficult on this basis to formulate conclusions that can be applied to the whole population of patients treated with DBS. Only a systematic study including an assessment of psychotic symptoms using scales and analysing the received treatment and stimulation parameters could give an idea of what is the most appropriate strategy in case of psychosis following DBS.

Efficacy and safety of antidepressant's use in the treatment of depressive episodes in bipolar disorder - review of research.

The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phase change risk. There are different opinions concerning recommended duration of antidepressant treatment. Generally antidepressant use should end after 2-3 months of remission, the risk of recurrence of depression after discontinuation of antidepressants is, however, higher than in case of continuation. In BD type II or BD spectrum, antidepressant monotherapy is allowed in severe depression. In bipolar disorder type I and in case of phase change after antidepressants use in the past, use of antidepressants should be very cautious. Antidepressants are contraindicated in rapid cycling and in mixed episodes. Further work is needed to evaluate the efficacy and safety of antidepressants use.