Ansiedad frente a exámenes, un tipo de ansiedad fóbica que se presenta en el contexto académico / Test anxiety, a type of phobic anxiety that occurs in the academic context

Experimentar ansiedad frente a exámenes desencadena una respuesta emocional acompañada de cambios fisiológicos que el estudiante siente ante una situación percibida como amenazante, específicamente ante una evaluación, examen escrito u oral; actualmente, se la cataloga dentro de las fobias específicas. El individuo que busca evitar o eludir dicho escenario cae en la conducta de procrastinación. Esto afecta su rendimiento académico y acarrea consecuencias graves de salud mental, el estudiante comienza a percibirse afectado en su autovalia, autoestima y en su ambiente social, que muchas veces lo lleva a contraer trastorno depresivo e ideación suicida. El presente artículo es un estudio de revisión bibliográfica y su objetivo fue describir la experiencia de la. ansiedad frente a exámenes como fobia específica situacional, las consecuencias de dicho padecimiento, su comorbilidad con otros trastornos psicológicos y los tratamientos disponibles. Fueron analizados y comparados unos 26 artículos científicos, basados en ensayos controlados de manera aleatoria, otros son estudios controlados de caso único, publicados en importantes revistas electrónicas de impacto. La búsqueda se realizó utilizando las palabras clave. Como conclusión, se destacó la importancia del conocimiento de esta patología, a fin de realizar un diagnóstico precoz y prevención en psicoterapia, evitando así un mayor deterioro en la salud mental de los estudiantes. No obstante, es necesaria la realización de más investigación controlada al respecto.

Experiencing test anxiety triggers an emotional response accompanied by physiological changes that the student feels in a situation perceived as threatening, specifically in the face of an evaluation, written or oral exam; Currently, it is classified as a specific phobia. The individual who seeks to avoid or avoid this scenario falls into procrastination behavior. This affects their academic performance and has serious mental health consequences. The student begins to feel affected in his or her self-worth, self-esteem, and social environment, which often leads him or her to contract a depressive disorder and suicidal ideation. This article is a bibliographic review study regarding experiencing test anxiety as a situational specific phobia, the consequences of said condition, its comorbidity with other psychological disorders and the available treatments. Some 26 scientific articles were analyzed and compared, based on randomized controlled trials, others are controlled single case studies, published in important impact electronic journals. The search was carried out using keywords. In conclusion, the importance of knowledge of this pathology was highlighted, in order to make an early diagnosis and prevention in psychotherapy, thus avoiding further deterioration in the mental health of students. However, more controlled research is needed in this regard.

Ansiedade e Depressão: rastreio entre profissionais da estratégia de saúde da família na Amazônia / Anxiety and Depression: screening among family health strategy professionals in the Amazon / Ansiedad y Depresión: tamizaje entre profesionales de estrategias de salud familiar en la Amazonía

Objetivo: realizar rastreamento de depressão e transtorno de ansiedade generalizada entre profissionais da Estratégia de Saúde da Família em um município no interior da Amazônia. Método:estudo transversal desenvolvido com 63 profissionais atuantes em 12 equipes de ESF na cidade de Santarém, Pará, Brasil. Foram utilizadas ferramentas validadas e adaptadas transculturalmente: o Patient ́s Health Questionaire ­9 e o Generalizes Anxiety Disorder ­7. Os dados foram analisados a partir de ferramentas da estatística descritiva (frequências absolutas e relativas) a partir do software Microsoft Excel 2018. Resultados:Houve predomínio de indivíduos do sexo feminino, na idade de 40 a 44 anos e raça/cor pardo. O estado civil predominante foi casado, a categoria profissional mais representada na amostra foram os agentes comunitários de saúde e o a maioria dos participantes possuía nível superior completo. 57.1% tiveram rastreamento positivo para depressão e 42.1% para ansiedade. Conclusão:Observou-se elevada frequência de ansiedade e depressão entre os profissionais incluídos na amostra. Nossos dados reforçam a necessidade de ações preventivas na área de saúde mental visando reduzir os impactos dos fatores de risco. Além disso, é fundamental a realização de grandes estudos voltados à investigação dos fatores associados à saúde mental dos trabalhadores da saúde no Brasil

Objective: To screen for depression and generalized anxiety disorder among Family Health Strategy professionals in a municipality in the interior of the Amazon. Method:A cross-sectional study was carried out with 63 professionals working in 12 FHS teams in the city of Santarém, Pará, Brazil. Cross-culturally adapted and validated tools were used: the Patient's Health Questionnaire -9 and the Generalized Anxiety Disorder -7. The data was analyzed using descriptive statistics tools (absolute and relative frequencies)using Microsoft Excel 2018 software. Results:There was a predominance of females, aged between 40 and 44 and of brown race/color. The predominant marital status was married, the most represented professional category in the sample were community health agents and the majority of participants had completed higher education. 57.1% were screened positive for depression and 42.1% for anxiety. Conclusion:There was a high frequency of anxiety and depression among the professionals included in the sample. Our data reinforces the need for preventive action in the area of mental health in order to reduce the impact of risk factors. In addition, it is essential to carry out large-scale studies investigating the factors associated with the mental health of health workers in Brazil.

Objetivo: Detectar depresión y ansiedad generalizada en profesionales de la Estrategia Salud de la Familia de un municipio del interior de la Amazonia. Método:Se realizó un estudio transversal con 63 profesionales que trabajan en 12 equipos de la ESF en la ciudad de Santarém, Pará, Brasil. Se utilizaron instrumentos validados y adaptados transculturalmente: el Cuestionario de Salud del Paciente -9 y el Trastorno de Ansiedad Generalizada -7. Los datos se analizaron mediante herramientas de estadística descriptiva (frecuencias absolutas y relativas) utilizando el software Microsoft Excel 2018. Resultados:Hubo un predominio de mujeres, con edades comprendidas entre 40 y 44 años y de raza/color moreno. El estado civil predominante fue casado, la categoría profesional más representada en la muestra fue la de agentes de salud comunitarios y la mayoría de los participantes habían completado estudios superiores. El 57,1% dieron positivo en depresión y el 42,1% en ansiedad. Conclusión:Hubo una elevada frecuencia de ansiedad y depresión entre los profesionales incluidos en la muestra. Nuestros datos refuerzan la necesidad de acciones preventivas en el área de la salud mental para reducir el impacto de los factores de riesgo. Además, es fundamental la realización de grandes estudios dirigidos a investigar los factores asociados a la salud mental de los trabajadores de la salud en Brasil

Higher IL-6 and IL-4 plasma levels in depressed elderly women are influenced by diabetes mellitus

Abstract Objective This study aimed at investigating a set of peripheral cytokines in elderly female patients with MDD, comparing them to controls, and assessing the potential influence of clinical comorbidities on inflammatory markers. Methods Twenty-five elderly female patients diagnosed with MDD and 19 age-matched female controls were enrolled on this study. Plasma levels of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were evaluated with commercially-available assays. Results Elderly female patients with MDD exhibited higher plasma IL-6 and IL-4 levels when compared to controls. In a logistic regression model taking cytokine levels, comorbidities, and age into account, only type 2 diabetes mellitus (DM2) remained associated with MDD. Conclusion Diabetes influences the association between MDD and higher levels of cytokines in elderly female patients. Future studies should take this evidence into account in order to mitigate confounding factors.

Influence of personality traits， resilience and coping style on the efficacy of sertraline treatment in female adolescents with first-episode depressive disorder / 四川精神卫生

BackgroundDepressive disorders are prevalence among adolescents， with a higher incidence in females compared to males， often accompanied by more severe depressive symptoms. Sertraline is commonly prescribed for adolescent depressive disorder， however， its efficacy is only evident in certain patients. Currently， there is limited research on predicting the therapeutic efficacy of sertraline in female adolescents with depressive disorder. ObjectiveTo explore the relationship between personality traits， psychological resilience， coping style and the clinical efficacy of sertraline treatment in female adolescents with first-episode depressive disorder， in order to provide references for the treatment of this population. MethodsA total of 112 female adolescent patients with first-episode depressive disorder， meeting the diagnostic criteria of the International Classification of Diseases （tenth edition） （ICD-10）， and undergoing a 4-week treatment regimen with sertraline， were selected from the Second People's Hospital of Guizhou Province from February 2019 to January 2021.General demographic questionnaire， NEO Five-Factor Inventory （NEO-FFI）， Resilience Scale for Chinese Adolescents （RSCA）， Coping Style Scale for Middle School Students （CSSMSS）， Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale-17 item （HAMD-17） were used for assessment. Logistic regression analysis was used to investigate the factors influencing the clinical efficacy of sertraline in the treatment of female adolescents with first-episode depressive disorder. ResultsNeuroticism （β=-0.115， 95% CI： 0.807~0.984） could negatively predicted the therapeutic efficacy of sertraline in female adolescents with first-episode depressive disorder， whereas agreeableness （β=0.129， 95% CI： 1.025~1.264） and RSCA score （β=0.062， 95% CI： 1.004~1.128） could positively predict its therapeutic efficacy. ConclusionHigh neuroticism， low agreeableness and low psychological resilience may be the risk factors for the poor therapeutic effect of sertraline in the treatment of female adolescents with first-episode depressive disorder. ［Funded by 2019 Guiyang Science and Technology Program （number， Zhuke Contract ［2019］9-3-1）］

Study of discrepancy in subjective and objective cognitive function in patients with depressive disorder / 四川精神卫生

BackgroundThere exist differences in the subjective and objective cognitive functions of patients with depressive disorder， ane there are limited research on influencing factors of such phenomenon currently. ObjectiveTo explore the differences in subjective and objective cognitive function in patients with depressive disorder as well as influencing factors， and to provide references for further understanding of cognitive impairment in patients with depressive disorder. MethodsA total of 77 patients with depressive disorder who received outpatient or inpatient treatment in the Fourth People's Hospital of Chengdu from January 13， 2022 to December 11， 2023 were selected for the study. These patients also met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition（DSM-5）. Various tools were employed to assess patients in this study： Montgomery-Asberg Depression Rating Scale （MADRS） for the depressive symptoms， Perceived Deficits Questionnaire for Depression （PDQ-D） and Chinese Version of Brief Neurocognitive Test Battery （C-BCT） for the subjective and objective cognitive function， Sheehan Disability Scale （SDS） for the social function， and Clinical Global Impression-Severity of Illness（CGI-SI） for the severity of patient's condition. Pearson correlation analysis was used to examine the correlation of subjective and objective cognitive function and their differences with age， years of education， MADRS total score， SDS total score， and CGI-SI score. Multiple linear regression was used to explore the influencing factors of the differences between subjective and objective cognitive function. ResultsThere was a statistically significant difference in the total PDQ-D scores and the difference of subjective and objective cognitive function （D value） between depressive patients with and without medication （t=-4.228， -2.392， P<0.05 or 0.01）. There was no statistically significant correlation in subjective and objective cognitive function in patients with depressive disorder （r=-0.148， P>0.05）. Negative correlations can be observed between the PDQ-D total score and age or years of education （r=-0.333， -0.369， P<0.01）. The PDQ-D total score was positively correlated with MADRS total score， SDS total score and CGI-SI score （r=0.487， 0.637， 0.434， P<0.01）. D value was negatively correlated with age and years of education （r=-0.411， -0.362， P<0.01）， while positively correlated with MADRS total score， SDS total score and CGI-SI score （r=0.259， 0.468， 0.299， P<0.05 or 0.01）. Age （β=-0.328， P<0.01） and SDS total score （β=0.409， P<0.01） were two predictive factors for D value. ConclusionThe difference between subjective and objective cognitive function among patients with depressive disorder is related to several factors including age， years of education， severity of symptoms and impairment of social function. ［Funded by Surface Project of National Natural Science Foundation of China （number， 62173069）； Technological Innovation 2030-Major Project of "Brain Science and Brain-Like Research" （number， 2022ZD0211700）； Key R&D Support Program and Major Application Demonstration Project of Chengdu Science and Technology Bureau （number， 2022-YF09-00023-SN）］

Risk Factors of Depression Screened by Two-Sample Mendelian Randomization Analysis: A Systematic Review / 生物医学与环境科学（英文）

OBJECTIVE@#This study explored the potentially modifiable factors for depression and major depressive disorder (MDD) from the MR-Base database and further evaluated the associations between drug targets with MDD.@*METHODS@#We analyzed two-sample of Mendelian randomization (2SMR) using genetic variant depression ( n = 113,154) and MDD ( n = 208,811) from Genome-Wide Association Studies (GWAS). Separate calculations were performed with modifiable risk factors from MR-Base for 1,001 genomes. The MR analysis was performed by screening drug targets with MDD in the DrugBank database to explore the therapeutic targets for MDD. Inverse variance weighted (IVW), fixed-effect inverse variance weighted (FE-IVW), MR-Egger, weighted median, and weighted mode were used for complementary calculation.@*RESULTS@#The potential causal relationship between modifiable risk factors and depression contained 459 results for depression and 424 for MDD. Also, the associations between drug targets and MDD showed that SLC6A4, GRIN2A, GRIN2C, SCN10A, and IL1B expression are associated with an increased risk of depression. In contrast, ADRB1, CHRNA3, HTR3A, GSTP1, and GABRG2 genes are candidate protective factors against depression.@*CONCLUSION@#This study identified the risk factors causally associated with depression and MDD, and estimated 10 drug targets with significant impact on MDD, providing essential information for formulating strategies to prevent and treat depression.

An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS)

Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. Conclusions: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials. Registration number: PROSPERO CRD42022296246.

Factores asociados con intento suicida en pacientes económicamente activos con diagnóstico de depresión mayor

Introducción: En el mundo, cada 40 segundos una persona se quita la vida; el suicidio se considera un problema de salud pública, y el intento de suicidio previo es uno de los factores de riesgo relacionados con suicidio consumado. A pesar de las estrategias implementadas y los estudios realizados, en Colombia las cifras de suicidio van en ascenso, de manera más marcada en la población económicamente activa. Objetivo: Identificar los factores sociodemográficos, familiares, personales, económicos y religiosos asociados con el intento suicida en pacientes con trastorno depresivo en edad productiva (18-62 arios), en una institución de salud mental en Bogotá, Colombia. Métodos: Se realizó un estudio de prevalencia analítica en la Clínica de Nuestra Señora de la Paz, de Bogotá; para explorar la relación entre los factores descritos y el intento suicida, se realizó una revisión de 350 historias clínicas de la población seleccionada. Resultados: El 37,7% de la muestra presentó intento de suicidio. Se encontraron asociaciones entre el intento de suicidio y la formación superior a primaria (RP = 0,47 [0,23-0,97]), no recibir ingresos (RP = 1,72 [1,13-2,61]), no tener pareja (RP = 2,10 [1,33-3,32]), el consumo de alcohol (p = 0,045), el consumo de alucinógenos (RP = 2,39 [0,97-3,43]) y la presencia de trastorno de personalidad (RP = 1,93 [1,11-3,34]). Conclusiones: Los resultados del estudio son similares a los descritos previamente en el mundo. Es necesario reconocer y abordar diversos factores asociados con el intento de suicidio en pacientes depresivos para desplegar acciones de promoción y prevención, identificación temprana e intervenciones específicas que impacten en las cifras de suicidio consumado en el país.

Introduction: Every 40 seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. Objective: To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. Methods: An analytical prevalence study was conducted at the Nuestra Señora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. Results: In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR = 0.47 [0.23-0.97]), no economic income (PR = 1.72 [1.13-2.61]), no partner (PR = 2.10 [1.33-3.32]), alcohol consumption (p = 0.045), hallucinogen use (PR = 2.39 [0.97-3.43]) and the presence of personality disorder (PR= 1.93 [1.11-3.34]). Conclusions: The results of the study are similar to those previously described in other studies around the world. There is a need to recognize and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Gravidade da depressão, resposta ao tratamento e PRO (incapacidade e QoL) em pacientes com DRT em um ano de acompanhamento com tratamento padrão: análise do subgrupo brasileiro do estudo observacional multinacional TRAL / Depression severity, treatment response and PRO (disability and QoL) in TRD patients over a 1-year follow-up with standard of care: Analysis of the Brazilian subset of the multicenter, observational TRAL study

Objetivo: A depressão resistente ao tratamento (DRT) é uma preocupação primária no Brasil devido à sua natureza onerosa e complexa, enquanto o diagnóstico e o tratamento geralmente são desafiadores. O presente manuscrito apresenta os resultados clínicos de um ano de acompanhamento em pacientes com DRT em tratamento padrão (SOC) no subgrupo brasileiro do estudo de Depressão Resistente ao Tratamento na América Latina (TRAL). Métodos: Essa fase longitudinal do estudo TRAL tinha como meta caracterizar alterações nos resultados clínicos e outras variáveis de interesse (p. ex., qualidade de vida, incapacidade) em um ano de acompanhamento em pacientes com DRT em 10 centros no Brasil. Os pacientes incluídos tinham diagnóstico clínico de DRT com base nos critérios DSM-5 e confirmado por MINI. A Escala de Depressão de Montgomery-Asberg (MADRS) era usada para avaliar a gravidade da doença e os resultados clínicos. Outras escalas de depressão e instrumentos classificados pelo paciente eram usadas para medir resultados correlacionados. Resultados: Cento e cinquenta e oito pacientes com DRT, na maioria mulheres (84,4%) com idade média de 48,55 anos, foram incluídos na análise. Apenas 31,4% dos pacientes apresentaram uma resposta clinicamente significativa, 10,3% tiveram recidiva e 26,7% alcançaram remissão, conforme medido pela MADRS no final do estudo (EOS). Aproximadamente 55% dos pacientes apresentavam depressão grave/moderadamente grave no EOS. Problemas de mobilidade, cuidados pessoais, problemas nas atividades usuais e dor e desconforto foram relatados pela maioria dos pacientes no EOS, assim como comprometimento marcado/extremo das atividades no trabalho/escola e da vida social/das atividades de lazer no EOS. Conclusões: Os resultados clínicos alcançados atualmente ainda são notavelmente insatisfatórios para DRT. Portanto, o envolvimento de todas as partes interessadas é essencial para implementar protocolos de tratamento mais eficazes no Brasil.

Objective: Treatment-resistant depression (TRD) is a primary concern in Brazil due to its burdensome and complex nature, while diagnosis and treatment is often challenging. The current manuscript presents the clinical outcomes in a one-year follow-up of TRD patients under Standard-of-care (SOC) in the Brazilian subset of the Treatment-Resistant Depression in America Latina (TRAL) study. Methods: This longitudinal phase of TRAL aimed to characterize changes in the clinical outcomes and other variables of interest (e.g. quality of life, disability) in a one-year follow-up of TRD patients in 10 centers in Brazil. Included patients were clinically diagnosed with TRD based on DSM-5 criteria and confirmed by MINI. Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess disease severity and clinical outcomes. Other depression scales and patient rated instruments were used to measure correlated outcomes. Results: One hundred fifty-eight TRD patients, mostly female (84.4%), averaging 48.55 years, were included in the analysis. Only 31.4% of the patients showed a clinically significant response, 10.3% had a relapse and 26.7% achieved remission, as measured through MADRS at end-of-study (EOS). Almost 55% of the patients showed moderately severe/severe depression at EOS. Mobility issues, self-care, problems with usual activities and pain and discomfort were reported by the majority of the patients at EOS, as well as marked/extreme disruption of school/work and social life/leisure activities at EOS. Conclusions: Currently achieved clinical outcomes are still remarkably unsatisfactory for TRD. Therefore, the involvement of all relevant stakeholders is essential to implement more effective treatment protocols in Brazil.

Mapping the modulating effect of transcutaneous auricular vagus nerve stimulation on voxel-based analyses in patients with first-episode major depressive disorder: a resting-state functional magnetic resonance imaging study

Introduction: Seed-based analysis has shown that transcutaneous auricular vagus nerve stimulation (taVNS) can modulate the dysfunctional brain network in patients with major depressive disorder (MDD). However, the voxel-based neuropsychological mechanism of taVNS on patients with first-episode MDD is poorly understood. The objective of this study was to assess the effects of an 8-week course of taVNS on patients with first-episode MDD. Methods: Twenty-two patients with first-episode MDD accepted an 8-week course of taVNS treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment. Voxel-based analyses were performed to characterize spontaneous brain activity. Healthy controls (n=23) were recruited to minimize test-retest effects. Analysis of covariance (ANCOVA) was performed to ascertain treatment-related changes. Then, correlations between changes in brain activity and the Hamilton Depression Rating Scale (HAM-D)/Hamilton Anxiety Scale (HAM-A) remission rate were estimated. Results: Significant group-by-time interactions on voxel-based analyses were observed in the inferior ventral striatum (VSi) and precuneus. Post-hoc analyses showed that taVNS inhibited higher brain activity in the VSi, while upregulating it in the precuneus. Functional connectivity (FC) between the VSi and precuneus decreased. Positive correlations were found between the HAM-D remission rate and changes in brain activity in the VSi. Conclusion: taVNS reduced the FC between VSi and precuneus by normalizing the abnormal spontaneous brain activity of VSi in first-episode MDD patients.

Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Positive screening for major depressive disorder in high-risk pregnant women / Triagem positiva para transtorno depressivo maior em gestantes de alto risco

ABSTRACT Objective: To estimate the frequency of positive screening for major depressive disorder and associated factors in high-risk pregnant women at a reference hospital of the Brazilian Public Health System. Methods: Cross-sectional study with 184 high-risk pregnant women at the Maternity at the Hospital Regional de São José , SC, Brazil. Positive screening for major depressive disorder using the Edinburgh Postpartum Depression Scale was selected as the dependent variable. Socio-demographic and pregnancy-related variables were also collected. Data were analyzed using Poisson regression with a robust estimator, including all variables that presented a p-value < 0.20 in the bivariate analysis. Statistically significant differences were considered when p ≤ 0.05. Results: The frequency of positive screening for major depressive disorder was 37.5%. Non-white skin color, income of less than USD 572,56 per month and maternal age of less than 18 years or greater than or equal to 35 years were statistically and independently associated with positive screening for major depressive disorder in high-risk pregnant women. Conclusion: The frequency of positive screening for major depressive disorder in the high-risk pregnant women studied was 37.5%. The frequency was statistically associated with skin color, family income and extremes in the maternal age.

RESUMO Objetivo: Estimar a frequência de rastreio positivo de transtorno depressivo maior e fatores associados em gestantes de alto risco em uma maternidade de referência do Sistema Único de Saúde. Métodos: Estudo transversal envolvendo 184 gestantes de alto risco da Maternidade do Hospital Regional de São José, SC, Brasil. A variável dependente foi o rastreio de transtorno depressivo maior por meio da aplicação da Escala de Depressão Pós-parto de Edimburgo. Foram coletadas ainda variáveis sociodemográficas e relacionadas à gestação. Os dados foram analisados por meio da regressão de Poisson com estimador robusto, incluindo todas as variáveis que apresentaram valor de p < 0,20 na análise bivariada. Consideraram-se diferenças estatisticamente significativas quando p ≤ 0,05. Resultados: A frequência de rastreio positivo para transtorno depressivo foi de 37,5%. Cor da pele não branca, renda mensal inferior a USD 572,56 e idade materna inferior a 18 anos ou superior ou igual a 35 anos foram estatística e independentemente associadas ao rastreamento positivo para transtorno depressivo maior em gestantes de alto risco. Conclusão: A frequência de rastreio positivo de transtorno depressivo maior em gestantes de alto risco estudadas foi de 37,5%. A frequência mostrou-se estatisticamente associada com cor de pele, renda familiar e extremos de idade materna.

Randomized clinical trial on the efficacy of a new transcranial direct current stimulation (tDCS) device in the treatment of depression: a low-cost option for developing countries? / Ensaio clínico randomizado sobre a eficácia de novo equipamento de estimulação transcraniana por corrente contínua (ETCC) no tratamento da depressão: uma opção de baixo custo para países em desenvolvimento?

ABSTRACT Objective: Verify the clinical efficacy and safety of a low-cost tDCS device, in a clinical trial for major depressive disorder. Methods: 168 persons were recruited; 32 depressed individuals with moderate or severe depressive symptoms (HDRS17 scores higher than 18) were included and randomized for the trial (16 individuals in each group). The intervention consisted of 10 active anodal tDCS sessions at 2 mA for 30 minutes over the left dorsolateral prefrontal cortex; or sham. The main outcome was HDRS17; secondary outcomes included satisfaction (TSQM II) and quality of life (WHOQOL-BREF). Assessments at baseline, endpoint and at 30 days follow-up. Results: The sample was composed by a total of 11 men and 21 women, mean age of 42.75 years (95% CI: 38.10-47.40). Active treatment was superior than sham: There was a significant interaction between group and time regarding HDRS-17 scores (F = 4.089, df = 2, p = 0.029; partial Eta squared = 0. 239). Post hoc analyses exhibited a statistically significant difference between active and sham group symptoms after a 30 days follow-up (difference = -7.75, p = 0.008, Cohen's d = 1.069). There were 3 dropouts, all in the active group, due schedule issues. No severe adverse effects reported. Conclusion: The current active tDCS protocol was related with clinical improvement of depressive symptoms. Intervention was well-tolerated. Non-invasive brain stimulation techniques are still not routinely used, although a viable strategy for treatment-resistant patients, partial responders and people unable to use pharmacological treatment. We aim to increase knowledge and use of tDCS for the Brazilian population.

RESUMO Objetivo: Testar a eficácia clínica e a segurança de equipamento de estimulação elétrica transcraniana por corrente contínua (ETCC) de baixo custo em ensaio clínico para transtorno depressivo maior (TDM). Métodos: Foram recrutadas 168 pessoas e incluídos e randomizados 32 indivíduos com depressão moderada ou grave (escores na HDRS17 >18; 16 indivíduos em cada grupo). A intervenção consistiu de 10 sessões de ETCC ativa a 2 mA no córtex pré-frontal dorsolateral esquerdo por 30 minutos, ou sham. O desfecho principal foi HDRS17; os desfechos secundários foram satisfação (TSQM II) e qualidade de vida (WHOQOL-BREF). Avaliações no início, no final do tratamento e após 30 dias de seguimento. Resultados: A amostra foi composta de 11 homens e 21 mulheres, com idade média de 42,75 anos (IC 95%: 38,10 a 47,40). O tratamento ativo foi superior ao sham: houve interação significativa entre grupo e tempo em relação aos escores de HDRS17 na ANOVA (F = 4,089, df = 2, p = 0,029; partial Eta squared = 0,239). A análise post hoc mostrou diferença significativa na HDRS17 no follow-up após 30 dias (diferença = -7,75, p= 0,008, Cohen's d = 1,069). Houve 3 dropouts, todos no grupo ativo, devido a problemas de agenda. Não houve registro de efeitos adversos graves. Conclusão: O tratamento ativo teve relação com melhora clínica de sintomas depressivos. A intervenção foi bem tolerada. Técnicas de estimulação cerebral não invasivas ainda não são rotina na prática clínica, apesar de estratégias viáveis para pacientes resistentes a tratamento, respondedores parciais e pessoas com intolerância a medicamentos. Esperamos ampliar o conhecimento e o uso de protocolos de ETCC na população brasileira.

Depressive and eating disorders in patients post-bariatric surgery with weight regain: a descriptive observational study / Transtorno depressivo e alimentar em pacientes pós-bariátricos cirurgia bariátrica com reganho de peso: um estudo observacional descritivo

ABSTRACT BACKGROUND: Although bariatric surgery is today's gold standard treatment for obesity, weight regain affects the success rate of the procedure. Recent studies have identified psychiatric and neurological factors as possible causes. AIMS: The aim of this study was to evaluate the influence of psychiatric diseases on the outcome and long-term success of bariatric surgeries and find a weight regain threshold that has an acceptable sensibility to mental health-related issues to be used in research and clinical studies. METHODS: This is a observational study of bariatric patients submitted to Roux-en-Y bypass or sleeve gastrectomy, with a postoperative time of 2-10 years to access weight regain, depression, and binge-eating disorder. RESULTS: Of 217 patients studied, 163 were women and 54 were men, with an average postoperative time of 5.2±2.6 years. Weight regain was experienced in 35% of the patients, binge-eating disorder in 24.9%, and depression in 24%. The greater weight before surgery, body mass index (BMI), percentage increase to maximum weight loss, and time postoperatively all have a significant positive correlation with weight regain (p=0.045, p=0.026, p<0.001, and p<0.001, respectively). A significant association between binge-eating disorder, depression, and anxiety with weight regain (p=0.004, p=0.008, and p=0.001, respectively) was found. CONCLUSIONS: The significant weight regain rates with significant impact on psychiatric disorders highlight the need for continuous postoperative monitoring focused on the psychiatric aspects of obesity to aid surgeries' long-term success.

RESUMO INTRODUÇÃO: Embora a cirurgia bariátrica atualmente é considerada o tratamento padrão ouro para a obesidade, o reganho de peso afeta a taxa de sucesso do procedimento. Estudos recentes identificaram fatores psiquiátricos e neurológicos como possíveis causas. OBJETIVOS: Avaliar a influência de transtornos psiquiátricos no resultado a longo prazo das cirurgias bariátricas; testar a sensibilidade e correlação das fórmulas de reganho de peso e de seus respectivos pontos de corte para questões relacionadas à saúde mental. MÉTODOS: Estudo observacional de pacientes pós bariátricos submetidos à by-pass em Y de Roux ou gastrectomia vertical com pós-operatório de 2 a10 anos avaliados quanto a reganho de peso, depressão e transtorno da compulsão alimentar. RESULTADOS: Foram avaliados 217 pacientes, 163 mulheres e 54 homens com pós-operatório de 5,2±2,6 anos. O reganho de peso foi registrado em 35% dos pacientes, o transtorno da compulsão alimentar (TCA) foi encontrado em 24,9% e depressão em 24%. O ganho de peso pré-operatório, o índice de massa corporea (IMC), o aumento percentual para perda máxima de peso e tempo de pós-operatório, apresentaram correlação positiva significativa com o reganho de peso (p=0,045), (p=0,026), (<0,001), (<0,001). Foi encontrada associação significativa entre TCA, depressão e ansiedade com reganho de peso (p=0,004), (p=0,008) e (p=0,001). CONCLUSÕES: As taxas significativas de reganho de peso associado ao impacto dos transtornos psiquiátricos reforçam a necessidade de acompanhamento pós-operatório contínuo focado nos aspectos psiquiátricos da obesidade, para sucesso do tratamento cirúrgico em longo prazo.

Tasa de egreso hospitalario por episodio depresivo recurrente en los años 2018-2021 en Chile / Hospital discharge rate due to recurrent depressive episode in the years 2018-2021 in Chile

Introducción: La depresión es un trastorno del ánimo frecuente, cuya recurrencia altera su manejo y pronóstico. El objetivo del trabajo es describir la tasa de egreso hospitalario (TEH) por episodio depresivo recurrente (EDR) entre 2018-2021 en Chile, según sexo, edad y gravedad. Materiales y métodos: Estudio observacional y transversal que considera los egresos hospitalarios por EDR en el período 2018-2021 en Chile (N=1551). Se utilizaron las bases de datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadística. Las variables estudiadas fueron sexo, grupo etario y gravedad. No requirió aprobación de comité de ética. Resultados: Se observó la menor TEH en 2020 con 1,91 egresos por cada 100.000 habitantes. Las mujeres sobresalieron durante todo el período con una TEH de 3,68 egresos por cada 100.000 habitantes. Destacó el grupo de 15 a 19 años con la mayor TEH en ambos sexos con 5,3 egresos por cada 100.000 habitantes. Respecto a gravedad, las hospitalizaciones se concentraron en pacientes de diagnóstico no especificado. Discusión: La pandemia de COVID 19 podría explicar la disminución de la TEH en 2020, al reducirse el diagnóstico y hospitalización por EDR; presumiblemente debido al fenómeno de reconversión de camas. La TEH es mayor en el sexo femenino, lo cual es concordante con la literatura. El predominio del grupo de 15 a 19 años discrepa de la evidencia, la cual indica que suele concentrarse en individuos de 25 a 64 años. Conclusión: Las TEH por EDR se concentraron en mujeres jóvenes. Es relevante conocer la epidemiología local para focalizar los recursos en la detección oportuna de factores de riesgo, para evitar episodios graves y disminuir su recurrencia.

Introduction: Depression is a common mood disorder, whose recurrence alters its management and prognosis. The aim of the paper is to describe the hospital discharge rate (HED) for recurrent depressive episode (RDE) between 2018-2021 in Chile, according to sex, age and severity. Materials and methods: Observational and cross-sectional study considering hospital discharges due to DRE in the period 2018-2021 in Chile (N=1551). The databases of the Department of Health Statistics and Information and the National Institute of Statistics were used. The variables studied were sex, age group and severity. Ethics committee approval was not required. Results: The lowest HTE was observed in 2020 with 1.91 discharges per 100,000 inhabitants. Females stood out during the entire period with an HTE of 3.68 discharges per 100,000 population. The 15-19 years age group stood out with the highest HTE in both sexes with 5.3 admissions per 100,000 inhabitants. In terms of severity, hospitalizations were concentrated in patients with unspecified diagnosis. Discussion: The COVID 19 pandemic could explain the decrease in HTE in 2020, with a reduction in diagnosis and hospitalization for RDE, presumably due to the bed conversion phenomenon. HTE is higher in the female sex, which is consistent with the literature. The predominance of the 15 to 19 years age group disagrees with the evidence, which indicates that it tends to be concentrated in individuals aged 25 to 64 years. Conclusion: HTE due to DRE was concentrated in young women. It is important to know the local epidemiology in order to focus resources on the timely detection of risk factors to avoid serious episodes and reduce their recurrence.

Influência das variantes genéticas do gene IL6 no transtorno depressivo maior: uma revisão / nfluence of IL6 gene genetic variants on major depressive disorder: a review / Influencia de las variantes genéticas del gen IL6 en el trastorno depresivo mayor: una revisión

Objetivo:Elucidar o quadro clínico do transtorno depressivo maior (TDM) e verificar a associação dessa condição com polimorfismos do gene IL6. Método:Tratou-se de uma revisão sistemática com a busca de artigos originais nas bases de dados Scopus, Web of Science, PubMed e BVS, os quais trouxeram informações sobre variantes genéticas que tinham relação com polimorfismos do gene IL6. Estudos que não apresentaram dados completos, inclusive dados estatísticos, revisões, meta-análises e resumos, foram excluídos. Resultados:Foram encontrados 54 artigos nas bases de dados. Utilizou-se a plataforma Rayyan para retirar as duplicatas e ler os resumos para seleçãoinicial. Restaram 12 artigos, onde os que eram de acesso livre foram encaminhados para leitura completa, totalizando 5 artigos para essa revisão. Conclusão:Evidências sugerem uma condição sistêmica no TDM e dados demonstram alterações inflamatórias. Dadoque na maior parte dos estudos pacientes com TDM tiveram estados inflamatórios mais elevados, parece haver relação entre a IL-6 e o transtorno. A IL-6 induz alterações no cérebro, ativação de microglia e controla a saúde dos neurônios, podendo tornar tangível uma relação dos polimorfismos com a doença, mas ainda não existem muitos estudos na área

Objective:To elucidate the clinical picture of major depressive disorder (MDD) and to verify the association of this condition with polymorphisms of the IL6 gene. Method:This was a systematic review with the search of original articles in the databases Scopus, Web of Science, PubMed and VHL, which brought information about genetic variants that were related to polymorphisms of the IL6 gene. Studies that did not present complete data, including statistical data, reviews, meta-analyses and abstracts, were excluded. Results:A total of 54 articles were found in the databases. The Rayyan platform was used to remove the duplicates and read the abstracts for initial selection. There were 12 articles, where those that were freely accessible were sent for full reading, totaling 5 articles for this review. Conclusion:Evidence suggests a systemic condition in MDD and data demonstrate inflammatory changes. Given that in most studies patients with MDD had higher inflammatory states, there seems to be a relationship between IL-6 and the disorder. IL-6 induces changes in the brain, activation of microglia and controls the health of neurons, and may make tangible a relationship between polymorphisms and the disease, but there are not many studies in the area.

Objetivo: Dilucidar el cuadro clínico del trastorno depresivo mayor (TDM) y verificar la asociación de esta condición con polimorfismos del gen IL6. Método: Se trata de una revisión sistemática con búsqueda de artículos originales en las bases de datos Scopus, Web of Science, PubMed y BVS, que aportaron información sobre variantes genéticas relacionadas con polimorfismos del gen IL6. Se excluyeron los estudios que no presentaron datos completos, incluidos datos estadísticos, revisiones, metanálisis y resúmenes. Resultados:Se encontraron un total de 54 artículos en las bases de datos. La plataforma Rayyan se utilizó para eliminar los duplicados y leer los resúmenes para la selección inicial. Hubo 12 artículos, donde aquellos que eran de libre acceso fueron enviados para lectura completa, totalizando 5 artículos para esta revisión. Conclusión:La evidencia sugiere una condición sistémica en el TDM y los datos demuestran cambios inflamatorios. Dado que en la mayoría de los estudios los pacientes con TDM tenían estados inflamatorios más altos, parece haber una relación entre la IL-6 y el trastorno. La IL-6 induce cambios en el cerebro, la activación de la microglía y controla la salud de las neuronas, y puede hacer tangible una relación entre los polimorfismos y la enfermedad, pero no hay muchos estudios en el área.

Alterações de sono em pacientes depressivos adultos: uma revisão integrativa / Sleep changes in adult depressive patients: an integrative review / Cambios del sueño en pacientes depresivos adultos: una revisión integradora

Esta é uma revisão da literatura que tem como objetivo elucidar as alterações do sono em pacientes adultos com depressão, principalmente sem outras comorbidades ou condições especiais, e estabelecer a relação entre distúrbios do sono e depressão, com foco no Transtorno Depressivo Maior. A metodologia envolve uma revisão integrativa da literatura dos últimos 15 anos (2009-2023) nas bases de dados Biblioteca Virtual em Saúde (BVS) e Pubmed, utilizando as palavras-chave "distúrbios do sono", "depressão" e "adultos". Os resultados mostram um total de 240 artigos, dos quais 26 foram selecionados e 12 foram incluídos na análise. A discussão destaca o interesse recente em estudar as associações entre distúrbios do sono e transtornos depressivos, bem como a natureza global da pesquisa. A relação entre sono e saúde mental, bem como a classificação e relação entre distúrbios do sono, também são discutidos. Os achados indicam que distúrbios do sono são prevalentes em pacientes com depressão, sendo a insônia um fator de risco significativo para o desenvolvimento da depressão. A relação bidirecional entre sono e depressão é destacada, com a depressão afetando o sono e o sono afetando a depressão. A importância de estudar os mecanismos por trás dessa relação é enfatizada, pois pode ajudar os psiquiatras a gerenciar de forma mais eficaz a comorbidade de depressão e distúrbios do sono. O tratamento adequado dos distúrbios do sono também pode desempenhar um papel vital na melhoria do prognóstico e na prevenção da recorrência da depressão.

This is a literature review that aims to elucidate the sleep alterations in adult patients with depression, primarily without other comorbidities or special conditions, and establish the relationship between sleep disturbances and depression, with a focus on Major Depressive Disorder. The methodology involves an integrative review of the literature from the last 15 years (2009-2023) on the databases Biblioteca Virtual em Saúde (BVS) and Pubmed, using the keywords "sleep disorders," "depression," and "adults." The results show a total of 240 articles, 26 of which were selected and 12 of which were included in the analysis. The discussion highlights the recent interest in studying the associations between sleep disturbances and depressive disorders, as well as the global nature of the research. The relationship between sleep and mental health, as well as the classification and relationship between sleep disturbances, are also discussed. The findings indicate that sleep disturbances are prevalent in patients with depression, with insomnia being a significant risk factor for the development of depression. The bidirectional relationship between sleep and depression is highlighted, with depression affecting sleep and sleep affecting depression. The importance of studying the mechanisms behind this relationship is emphasized, as it can help psychiatrists manage the comorbidity of depression and sleep disturbances more effectively. Adequate treatment of sleep disturbances may also play a vital role in improving the prognosis and preventing the recurrence of depression.

Esta es una revisión de la literatura que tiene como objetivo dilucidar las alteraciones del sueño en pacientes adultos con depresión, principalmente sin otras comorbilidades o condiciones especiales, y establecer la relación entre las alteraciones del sueño y la depresión, con un enfoque en el Trastorno Depresivo Mayor. La metodología consiste en una revisión integradora de la literatura de los últimos 15 años (2009-2023) en las bases de datos Biblioteca Virtual em Saúde (BVS) y Pubmed, utilizando las palabras clave "sleep disorders," "depression," y "adults." Los resultados muestran un total de 240 artículos, de los cuales 26 fueron seleccionados y 12 incluidos en el análisis. La discusión destaca el reciente interés por estudiar las asociaciones entre las alteraciones del sueño y los trastornos depresivos, así como el carácter global de la investigación. También se analiza la relación entre el sueño y la salud mental, así como la clasificación y la relación entre los trastornos del sueño. Los resultados indican que las alteraciones del sueño son prevalentes en pacientes con depresión, siendo el insomnio un factor de riesgo significativo para el desarrollo de la depresión. Se destaca la relación bidireccional entre sueño y depresión, en la que la depresión afecta al sueño y el sueño a la depresión. Se subraya la importancia de estudiar los mecanismos que subyacen a esta relación, ya que puede ayudar a los psiquiatras a gestionar la comorbilidad de la depresión y los trastornos del sueño de forma más eficaz. El tratamiento adecuado de los trastornos del sueño también puede desempeñar un papel vital en la mejora del pronóstico y la prevención de la recurrencia de la depresión.

Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression / Transtorno depressivo maior como fator de risco para ideação suicida em alunos de instituições educacionais: uma metanálise e metarregressão

Abstract Objective: This study aimed to analyze the effect of major depressive disorder (MDD) as a risk factor for suicidal ideation in individuals whose ages varied from 11 to 24 years and who were attending educational institutions. Data source: A systematic review was carried out by searching in PubMed and Biblioteca Virtual em Saúde (BVS). Original studies conducted in educational institutions, including individuals whose age varied from 11 to 24 years, in English, Spanish, or Portuguese were included. Data synthesis: Eight studies were selected for the meta-analysis, including 35,443 youths, with an average age of 16.8 years, predominantly female (51.2%), and from middle-income Asian countries (91.6%). An odds ratio of MDD of 3.89 (95%CI 2.46-6.17) for suicide ideation in youth was found. Subgroup analysis showed higher effects in Asia (OR=4.71; 95%CI 3.22-6.89) than Americas (OR=1.71; 95%CI 1.44-2.03). The meta-regression model indicated that younger adolescents (coef=-0.63; 95%CI 1.09--0.18; p<0.01) and older studies (coef=-0.23; 95%CI 0.039--0.08; p<0.01) presented higher effects of MDD on suicidal ideation. Conclusions: Early detection and treatment of MDD in youth patients are of utmost importance for preventing suicidal ideation. Educational institutions could play an important role in the early detection and intervention.

Resumo Objetivo: Analisar o efeito do transtorno depressivo maior (TDM) como fator de risco para a ideação suicida em indivíduos com idades entre 11 e 24 anos que frequentam instituições de ensino. Fontes de dados: Revisão sistemática realizada até agosto de 2020 por meio de buscas nas bases United States National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS), sem limitações quanto à data de publicação. Síntese dos dados: Oito estudos foram selecionados para a metanálise, incluindo 35.443 jovens com idade média de 16,8 anos, predominantemente do sexo feminino (51,2%) e de países asiáticos de renda média (91,6%). Foi encontrado odds ratio (OR) de TDM de 3,89 (intervalo de confiança — IC95% 2,46-6,17) para a ideação suicida em jovens. A análise de subgrupo mostrou efeitos maiores na Ásia (OR=4,71; IC95% 3,22-6,89) do que nas Américas (OR=1,71; IC95% 1,44-2,03). O modelo de metarregressão demonstrou que adolescentes mais jovens (coef=-0,63; IC95% -1,09--0,18; p＜0,01) e estudos mais antigos (coef=-0,23; IC95% -0,039--0,08; p＜0,01) apresentaram maiores efeitos do TDM sobre a ideação suicida. Conclusões: Observou-se relação entre TDM e ideação suicida no continente asiático, entre adolescentes mais jovens e em estudos mais antigos.

Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial

Abstract Objectives Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels - neither with ketamine nor esketamine - despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Internet addiction and depressive symptoms: a dose-response effect mediated by levels of physical activity

Abstract Introduction There are several negative impacts on the physical and mental health of people presenting internet addiction, including development of mood disorders, such as depression. Objective The aim of the study was to evaluate the association between internet addiction and depressive symptoms, as well as to test the mediating role of physical activity in this association. Methods A cross-sectional study was conducted with undergraduate students from three universities (one private and two public institutions) in southern Brazil. Depressive symptoms were measured with the Beck Depression Inventory (BDI-21), internet addiction with the Internet Addiction Test (IAT-20), and physical activity with the International Physical Activity Questionnaire (IPAQ - short version). Poisson regression and the Karlson-Holm-Breen mediation method were used for statistical analyses. Results We observed a dose-response relationship between internet addiction and depressive symptoms. Levels of physical activity mediated the association between moderate internet addiction and depressive symptoms, accounting for 10.7% of the effect observed. Conclusion Internet addiction can be detrimental to individuals' health, contributing to development of depressive symptoms. Along with psychological and pharmacological therapies, prescription of physical activities is recommended.