Assuntos
Depressão , Transtorno Depressivo , Antidepressivos/uso terapêutico , Terapia Combinada , Depressão/tratamento farmacológico , Depressão/história , Depressão/terapia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/história , Transtorno Depressivo/terapia , Eletroconvulsoterapia , Terapia por Exercício , História do Século XX , Humanos , Psicoterapia/métodos , Psicoterapia/tendênciasRESUMO
Medicine and health is one of the most popular subject fields on the Internet. An increasing number of people are now getting access to these services. NetDoktor Depression, a part of Netdoktor.se, makes it possible for the visitor to read articles about depression and the treatments for the disease, take interactive tests, discuss with other people and submit questions the medical experts. The aim of this study has been to examine how individuals are affected by the active use of an Internet community site--NetDoktor Depression--dealing with depressive disorders. Our conclusion is that the Internet seems to have the potential to provide an important function for depressed people.
Assuntos
Depressão/terapia , Transtorno Depressivo/terapia , Internet , Educação de Pacientes como Assunto , Apoio Social , Atitude Frente a Saúde , Depressão/psicologia , Transtorno Depressivo/psicologia , Humanos , Disseminação de Informação , Inquéritos e Questionários , SuéciaAssuntos
Liderança , Serviços de Saúde Mental , Psiquiatria , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Psiquiatria/educação , Psiquiatria/organização & administração , Psiquiatria/tendências , Psicoterapia/educação , Suécia , Recursos HumanosAssuntos
Política de Saúde/economia , Serviços de Saúde Mental/economia , Psiquiatria/economia , Reforma dos Serviços de Saúde/economia , Humanos , Serviços de Saúde Mental/organização & administração , Psiquiatria/organização & administração , Alocação de Recursos/economia , Alocação de Recursos/organização & administração , SuéciaRESUMO
The biochemical basis of major depression (MD) in Parkinson's disease (PD) is largely unknown. To increase our understanding of MD in PD patients, the levels of monoamine metabolites (HVA, 5-HIAA and MHPG), BDNF, orexin-A, IL-6 and corticosterone were examined in cerebrospinal fluid. The analyses were performed in MD patients with (n = 11) and without (n = 12) PD at baseline and after 12 weeks' of treatment with the antidepressant citalopram, and in patients with solely PD (n = 14) at baseline and after 12 weeks. The major findings were that PD patients with MD had significantly lower baseline levels of MHPG, corticosterone and IL-6 when compared to patients with solely MD. In response to citalopram treatment, patients with solely MD exhibited an expected decrease in 5-HIAA and MHPG levels which was not found in PD patients with MD. Moreover, the levels of BDNF and IL-6 were lower in PD patients with MD compared with patients with solely MD after treatment with citalopram. Thus, the biochemical basis and the response to citalopram differ between PD patients with MD and patients with solely MD.
Assuntos
Monoaminas Biogênicas/líquido cefalorraquidiano , Fator Neurotrófico Derivado do Encéfalo/líquido cefalorraquidiano , Corticosterona/líquido cefalorraquidiano , Transtorno Depressivo Maior/líquido cefalorraquidiano , Interleucina-6/líquido cefalorraquidiano , Doença de Parkinson/líquido cefalorraquidiano , Idoso , Análise de Variância , Transtorno Depressivo Maior/tratamento farmacológico , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Ácido Homovanílico/líquido cefalorraquidiano , Humanos , Ácido Hidroxi-Indolacético/líquido cefalorraquidiano , Masculino , Metoxi-Hidroxifenilglicol/líquido cefalorraquidiano , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Radioimunoensaio/métodosAssuntos
Transtornos Psicóticos Afetivos/história , Transtornos do Humor/história , Neurobiologia/história , Psiquiatria/história , Transtornos Psicóticos Afetivos/diagnóstico , Transtornos Psicóticos Afetivos/epidemiologia , Transtornos Psicóticos Afetivos/terapia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/história , Transtorno Bipolar/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/história , Transtorno Depressivo/terapia , Feminino , História do Século XX , Humanos , Masculino , Serviços de Saúde Mental/história , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Suécia/epidemiologiaAssuntos
Reforma dos Serviços de Saúde , Serviços de Saúde Mental/organização & administração , Psiquiatria/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Humanos , Pessoas com Deficiência Mental/psicologia , Pessoas com Deficiência Mental/reabilitação , SuéciaAssuntos
Reforma dos Serviços de Saúde , Serviços de Saúde Mental/organização & administração , Psiquiatria/organização & administração , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Mental/economia , Psiquiatria/economia , SuéciaAssuntos
Transtornos Psicofisiológicos/diagnóstico , Licença Médica , Estresse Psicológico/diagnóstico , Síndrome de Fadiga Crônica/diagnóstico , Feminino , Humanos , Masculino , Transtornos Psicofisiológicos/epidemiologia , Licença Médica/estatística & dados numéricos , Licença Médica/tendências , Estresse Psicológico/complicações , Suécia/epidemiologia , Carga de TrabalhoRESUMO
Previously we suggested that major depression (MD) in Parkinson's disease (PD) could be an indication of a more advanced and widespread neurodegenerative process, as PD symptoms were more severe in those with depression. We also found a different antidepressant response with SSRI medication in PD patients with depression compared to depressed patients without PD. This indicates diverse underlying pathophysiological mechanisms. Investigations using single-photon emission computed tomography (SPECT), measuring regional cerebral blood flow (rCBF), may contribute to enlighten the neurobiological substrates linked to depressive symptoms. SPECT was performed in order to compare rCBF in MD patients with and without PD. The study included 11 MD patients with PD, 14 non-depressed PD patients and 12 MD patients without PD. All patients were followed for 12 weeks with repeated evaluation of depressive as well as PD symptoms. Anti-Parkinsonian treatment remained unchanged during the study. Antidepressant treatment with SSRI (citalopram) was given to all patients with MD. SPECT was performed before and after 12 weeks of antidepressant treatment. rCBF was found to differ between PD patients with and without MD, as well as between MD patients with and without PD, both at baseline and concerning the response to treatment with SSRI (citalopram). In patients with PD the rCBF was found to be decreased in preoccipital and occipital regions, a finding more common when PD was combined with MD. In summary, larger cortical areas were found to be involved in depressed PD patients, both with hyperactivity (reciprocal to basal degeneration in PD and maybe dopaminergic treatment) and with hypoactivity (probably due to organic lesions leading to hypoperfusion). These observations support our hypothesis that PD combined with MD is an expression of a more advanced and widespread neurodegenerative disorder.
Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Circulação Cerebrovascular , Citalopram/uso terapêutico , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/tratamento farmacológico , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/tratamento farmacológico , Idoso , Antiparkinsonianos/uso terapêutico , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Mapeamento Encefálico , Circulação Cerebrovascular/efeitos dos fármacos , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximas , Doença de Parkinson/fisiopatologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
OBJECTIVE: To study how implementation of a naturalistic trial design for mirtazapine treatment in major depressive disorder for six (up to 12) months could be used and evaluated by means of clinical efficacy and safety. METHOD: An open-labelled, prospective, multicenter, non-comparative trial was conducted during a 2-year period in patients with major depression according to DSM-IV treated in psychiatric departments and primary care in Sweden. Minimal inclusion and exclusion criteria were used in order to diminish the potential patient selection bias. Maximum flexibility of the dosage of mirtazapine was allowed, and clinical assessments included MADRS, CGI, vital signs and spontaneous reporting of adverse events. RESULTS: 192 patients were found eligible and enrolled in the study. A significant improvement in depressive symptoms according to MADRS and CGI was observed including particularly marked sleep improvement early in the treatment. Slight increases in body weight and BMI were observed. The investigational drug was well tolerated overall. CONCLUSION: The clinical efficacy and safety of mirtazapine found in this naturalistic setting is in line with previously reported data on mirtazapine in traditional controlled clinical trials. The results confirm that the naturalistic study design facilitated conduct of the trial. The authors suggest that this type of study design should also be applied to other antidepressant drugs that are frequently prescribed in the general population.
Assuntos
Antidepressivos Tricíclicos/uso terapêutico , Depressão/tratamento farmacológico , Mianserina/análogos & derivados , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos Tricíclicos/efeitos adversos , Índice de Massa Corporal , Relação Dose-Resposta a Droga , Avaliação de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Estudos Longitudinais , Masculino , Mianserina/efeitos adversos , Mianserina/uso terapêutico , Pessoa de Meia-Idade , Mirtazapina , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Suécia/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
The prescribing of selective serotonin reuptake inhibitors for adolescents is extensive despite the fact that there are few pharmacokinetic (PK), efficacy, safety, or tolerability studies on this group. This study reports the PK findings from two trials in adolescents treated with citalopram (CIT) in naturalistic clinical settings: one retrospective and one prospective. The aim of our study was to describe serum concentrations of CIT, desmethylcitalopram (DCIT), and didesmethylcitalopram (DDCIT) (trough values in steady state) in adolescents in relation to daily dose and clinical information obtained from therapeutic drug monitoring request forms. Altogether, 44 patients younger than 21 years were scrutinized using this combined open-label approach. The main findings were that (1) there was a pronounced interindividual variability of serum CIT, DCIT, and DDCIT concentrations in all doses prescribed, in agreement with previous studies on adults; on correcting for dose, the coefficient of variance was about 50% for CIT, DCIT, and DDCIT; (2) the transformation of CIT to DCIT and of DCIT to DDCIT was similar within the dose range 20 to 60 mg/day; (3) there was a difference between the sexes on comparing the dose-corrected concentrations of CIT and DCIT, with girls presenting significantly higher values than boys; and (4) there was a strong dose-serum concentration relationship in three identified subgroups of adolescents: (a) nonsmokers (CIT, r(2) = 0.71; DCIT, r(2) = 0.81), (b) girls not taking oral contraceptives (CIT, r(2) = 0.75; DCIT, r(2) = 0.71,), and (c) girls in the last 14 days of the menstrual cycle (CIT, r(2) = 0.68; DCIT, r(2) = 0.64). In summary, the present study tentatively supports influences of sex, oral contraceptives, and smoking habits on the disposition of CIT in younger patients. Hence, future studies on CIT should assess these parameters.