A Revision on the Effectiveness of Omega-3 Polyunsaturated Fatty Acids as Monotherapy in the Treatment of Major Depressive Disorder.

Background: Insufficient effectiveness and a difficult tolerability profile of antidepressant drugs for the treatment of major depressive disorder (MDD) have been reported, and polyunsaturated fatty acids (PUFAs) have been posited as reliable therapeutic alternatives. The present study investigated the efficacy of omega-3 PUFAs as monotherapy for MDD. Methods: Two well-trained reviewers independently looked at the most significant randomized clinical trials (RCTs) from the PubMed database regarding PUFAs' employment in MDD compared to placebo; "major depressive disorder" and "omega-3 fatty acids," or "omega-6 fatty acids," or "polyunsaturated fatty acids (PUFA)," or "n - 3 polyunsaturated fatty acids," or "eicosapentaenoic acid (EPA)," or "docosahexaenoic acid (DHA)" were used as the medical subject keywords. Results: Of the initial 96 potential RCTs based on titles and abstracts, 82 studies did not meet the inclusion criteria and were excluded. Six studies were excluded from the remaining 14 after full text revision. Eight RCTs met all the inclusion/exclusion criteria without reporting clear evidence of PUFAs' effectiveness in the treatment of MDD. Conclusion: At present, there is no opportunity to recommend the use of omega-3 PUFAs monotherapy for the treatment of MDD, although their supplementation may be useful in some specific populations.

[The Italian contribution to studies on the biological rhythms implicated in psychiatric disorders]. / Il contributo italiano agli studi sui ritmi biologici implicati nei disturbi psichiatrici.

This editorial summarizes the main studies, carried out in the last 10 years, by various Italian research groups, on the alterations of circadian rhythms in psychiatric disorders. The results of these researches, as well as those obtained in various international contexts, encourage to teach in the medical schools for psychiatry, about the new chronoterapeutic interventions and the implementation of combined therapies for increasingly personalized psychiatric therapies.

The relationship between Vitamin D and depressive disorders.

Studies have suggested a relationship between low circulating levels of Vitamin D and depression. Vitamin D deficiency may be a consequence of depression-related factors, such as reduced sun exposure, decreased outdoor activity, and dietary changes, but it can also play a role in the pathophysiology of depressive conditions through a range of molecular mechanisms. In the present manuscript, findings related to prospective longitudinal studies on the relationship between Vitamin D levels and depressive symptoms and to randomized controlled trials on Vitamin D supplementation for depressive disorders are reviewed.

[Disturbo dissociativo d'identità, auto-ipnosi e sintomi simil-psicotici: da un caso clinico a un problema di diagnosi differenziale].

We report a case of a forty-nine-year-old patient suffering from his first psychiatric episode, who required hospitalization in a psychiatric unit. The presence of mood alterations with Schneiderian first-rank symptoms could have suggested an initial diagnosis of bipolar disorder (BD) with psychotic symptoms, directing the patient towards a definite therapeutic process. However, we hypothesized that the presence of a clear dissociative state similar to the hypnotic trance preceded by an uncontrolled self-hypnosis process, the presence of 'inner voices' and a high vulnerability to dissociation, were all elements that may reasonably lead to a diagnosis of Dissociative Identity Disorder (DID). Several authors have reported the presence of psychotic-like symptoms in patients with DID. However, in clinical practice there is a tendency not to acknowledge the possibility of dissociative disorders diagnoses, in favor of others more frequent psychiatric disorders. This paper aims to highlight some etiopathogenetic and psychopathological features that might help clinicians in identifying a DID.

[Relaxation treatments and biofeedback for anxiety and somatic stress-related disorders]. / Terapie di rilassamento e biofeedback per ansia e disturbi somatici stress-correlati.

INTRODUCTION: Relaxation techniques (TR) and biofeedback (BFB) are widely used in psychiatric and psychological practice for the treatment for anxiety and stress-related disorders. METHODS: An examination of studies focusing on the correlates of psychophysiology of relaxation and biofeedback has been done, in addiction to controlled therapeutic studies that describes clinical aspects, efficacy and limits. RESULTS: There are different TR and BFB procedures, but they have the same goal and same physiological modifications, resulting in stress and anxiety reduction. There is a proven action to musculoskeletal, neuroendocrine and autonomic nervous system, showing similar results. Very few data on immune changes are available. Meta-Analysis show superior efficacy to no treatment or placebo in anxiety disorders, tension headache, bruxism, temporomandibular pain syndrome, rehabilitation and prevention of ischemic heart disease. Moderate efficacy is shown for chronic low back pain, cancer-related pain, rheumatoid arthritis and gastrointestinal disorders; data for essential hypertension are controversial. Variability of techniques, procedures, sampling problems, non-systematic make definitive conclusions difficult. TR and BFB are often used in combination with cognitive-behavioral and educational techniques. The association of the active relaxation technique facilitates generalization and self-control during stress situation and outside the training session. CONCLUSIONS: TR and BFB are effective for anxiety and somatic stress-related disorders, associated with coping and quality of life improvement and affordable costs; they are minimally invasive but needing an active participation in the treatment process. Some limits are responders' prediction, continuity of practice and limited effectiveness for depression disorders. Finally, it is shown that they are real psychosomatic therapies that are able to produce somatic peripheral changes (neuroendocrine, neurovegetative and muscular systems) generated by the mind and secondary to the involvement of central neurotransmitter circuits.

[Coffee consumption in depressive disorders: it's not one size fits all]. / Consumo di caffè nei disturbi depressivi: una dose giusta, non per tutti.

Caffeine is considered the world's most popular psychoactive substance. Its actions on the central nervous system, mainly mediated by antagonism of adenosine receptors and subsequent modulation of dopaminergic activity, would be particularly sought by depressed patients, as an attempt of self-medication. However, published data suggested that coffee consumption may worsen psychopathological conditions in mood disorders. Thus, we reviewed available evidence in the literature that investigated the effects of coffee consumption on clinical development of underlying psychopathology. Literature research was done by typing on Medline/PubMed and PsychINFO the key words "coffee AND major depression", "coffee AND dysthymia". The research was limited to English language publications and to studies conducted exclusively on humans. Although literature data are conflicting, extensive follow-up studies indicate a significant caffeine effect on risk reduction of developing clinical depression symptoms. Clinical worsening was observed mainly in cases of postpartum depression and comorbid panic disorder. Taking in account the study limitations, we observed a biphasic profile in caffeine psychostimulant effect: low to moderate doses may correlate with a reduction in depressive risk in healthy subjects and an improvement of many clinical symptoms (attention, arousal, psychomotor performance) in depressed patients, whereas the assumption of high doses may result in thymic dysregulation, favor mixed affective states and worsen circadian profiles and anxiety symptoms.