Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification.

Background/objective: The COVID-19 pandemic and consequent physical distancing has made it difficult to provide care for those with Treatment-Resistant Depression (TRD). As a secondary analysis of a clinical trial, the aim of this study was to explore potential mechanisms through which three online-delivered approaches, added to treatment as usual, improve depressive symptoms in TRD patients. Methods: The three approaches included (a) Minimal Lifestyle Intervention (MLI), (b) Mindfulness-Based Cognitive Therapy (MBCT), and (c) Lifestyle Modification Program (LMP). Sixty-six participants with TRD completed assessments pre-post intervention (mindfulness skills [FFMQ]; self-compassion [SCS]; and experiential avoidance [AAQ-II]) and pre-intervention to follow-up (depressive symptoms [BDI-II]). Data were analyzed using within-subjects regression models to test mediation. Results: Mindfulness skills mediated the effect of MBCT on depressive symptoms (ab = -4.69, 95% CI = -12.93 to-0.32), whereas the lack of experiential avoidance mediated the effect of LMP on depressive symptoms (ab = -3.22, 95% CI = -7.03 to-0.14). Conclusion: Strengthening mindfulness skills and decreasing experiential avoidance may promote recovery in patients with TRD, MBCT, and LMP have demonstrated that they may help increase mindfulness skills and decrease experiential avoidance, respectively. Future work will need to unpick the components of these interventions to help isolate active ingredients and increase optimization.

Efficacy of an adjuvant non-face-to-face multimodal lifestyle modification program for patients with treatment-resistant major depression: A randomized controlled trial.

BACKGROUND: The high prevalence of depression is partly attributable to the poor response of patients to first-line antidepressants. Multimodal programs that promote a healthy lifestyle are successful in treating depression when used as a complementary therapy, but their medium- and long-term benefits have not been demonstrated for patients with treatment-resistant depression (TRD). The main aim of this study was to compare the effectiveness of a lifestyle modification program (LMP) with mindfulness-based cognitive therapy (MBCT) and a placebo-control (written suggestions for lifestyle changes) in Spanish patients with TRD. METHODS: This controlled clinical trial randomized 94 patients with TRD into 3 arms. The primary outcome was the Beck Depression Inventory-II (BDI-II) score at baseline, 2, 6 and 12 months. The secondary outcomes were changes in scores that evaluated quality-of-life, adherence to the Mediterranean diet, physical activity, and social support. RESULTS: Relative to the placebo group, the LMP and MBCT groups had significantly better quality of life (p = 0.017; p = 0.027), and the LMP group had significantly better adherence to the Mediterranean diet (p<0.001) and reduced use of antidepressants (p = 0.036). However, the three groups showed no significant differences in BDI-II score. LIMITATIONS: Only about half of the planned 180 patients were recruited, in part due to the COVID-19 pandemic. CONCLUSIONS: There was no evidence that the LMP treatment significantly reduced symptoms of depression relative to the other groups during the COVID-19 lockdown.

Effectiveness of a healthy lifestyle promotion program as adjunctive teletherapy for treatment-resistant major depression during COVID 19 pandemic: A randomized clinical trial protocol.

INTRODUCTION: Treatment-resistant depression (TRD) has a high prevalence and can be exacerbated by poor physical health and economic hardships, which have become common stressors during the current COVID-19 pandemic. The therapeutic approaches used to treat these patients are not always available, may be not be accepted by some patients, and often require face-to-face interactions. OBJECTIVE: The main aim of this study will be to evaluate the effectiveness of an Internet-based adjuvant lifestyle-based intervention for patients with TRD. METHODS: This will be a parallel, randomized, and controlled clinical trial. A total of 180 patients with TRD will be randomly allocated (1:1:1) to 1 of 3 groups: treatment prescribed by the mental health team and written suggestions for lifestyle changes (placebo control group); treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week mindfulness-based cognitive therapy program (active control group); or treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week lifestyle change promotion program (intervention group). We will perform this study during the COVID-19 pandemic, and will administer interventions by teletherapy, and contact participants by telephone calls, text messages, and/or teleconferences. We will collect patient data using questionnaires administered at baseline, immediately after the intervention, and after 6 and 12 months. The primary outcome will be score on the Beck Depression Inventory-II. The secondary outcomes will be score on the Clinical Global Impressions Scale (used to quantify and track patient progress and treatment response over time) and health-related quality of life measured using the European Quality of Life-5 Dimensions Questionnaire. DISCUSSION: Patients with TRD are especially vulnerable when face-to-face psychotherapy is unavailable. The main strength of the proposed study is the novelty of the intervention to be used as an adjuvant therapy. Our results may provide guidance for treatment of patients with TRD in future situations that require lockdown measures. CLINICALTRIALS REGISTRATION NUMBER: NCT04428099.

Estilo de vida saludable: un factor de protección minusvalorado frente a la depresión / Healthy lifestyle: an undervalued protection factor against depression

Los índices de depresión en el mundo desarrollado se han incrementado en las últimas décadas. Según el informe de la OMS, publicado en 2012, aproximadamente el 5% de la población refiere haber experimentado un episodio depresivo en algún momento de su vida. En los últimos años se están investigado qué factores pueden ser los responsables, como la merma de la calidad de la dieta, de las horas de sueño, de la actividad física, de la exposición a luz ambiental o del lazo social. Todos estos factores aumentan la vulnerabilidad para la depresión hasta el punto de que, lo mismo que le ocurre a la diabetes o las enfermedades cardiovasculares, la depresión se considera como una «enfermedad de la modernidad», aludiendo a que los cambios en nuestras rutinas pueden predisponer la aparición de las mismas. En coherencia con ello, ayudar a que el paciente mejore sus hábitos de vida podría tener un impacto positivo en su clínica depresiva, como efectivamente se está demostrando. Los tratamientos de los que disponemos en la actualidad, como los fármacos o la psicoterapia, no siempre demuestran ser totalmente eficaces, y hay estimaciones de que solo en torno al 50% de los pacientes tratados por depresión presentan remisión total sin precisar otro tipo de intervenciones. En este trabajo describimos un programa multimodal de estilo de vida para pacientes con depresión que aborda los factores mencionados y que se ha denominado programa de «estilo de vida mediterráneo». Concluimos planteando que el estilo de vida saludable, aunque está en retroceso en muchas partes del mundo, es un factor protector frente a la depresión y muchos pacientes pueden recuperarlo con ayuda específica (AU)

Depression rates have increased in recent decades in the developed world. According to the WHO report published in 2012, approximately 5% of the population refer to having experienced a depressive episode at some point in their life. In the last few years, the factors responsible for reducing the quality of diet, sleeping hours, physical activity, exposure to ambient lighting, or social environment are being investigated. All of these factors increase the vulnerability to depression to the point that, like diabetes or cardiovascular disease, depression is considered as a "modern disease", referring to the changes we make in our lifestyles that may predispose to the appearance of these diseases. Consequently, helping patients to improve their lifestyles could have a positive impact on their depressive symptoms, as is being demonstrated. Current available treatments, such as drugs or psychotherapy, do not always prove to be fully effective, and there are estimates that only about 50% of patients treated for depression have total remission without requiring other interventions. In this paper, we describe a multimodal lifestyle program for patients with depression that addresses the above factors and has been labelled as the "Mediterranean lifestyle" program. It is concluded that healthy lifestyle (a regressive lifestyle in many parts of the world), is a protective factor against depression, and many patients can recover from it with specific help (AU)

The Mediterranean diet and micronutrient levels in depressive patients / Dieta mediterránea y niveles de micronutrientes en pacientes depresivos

Introduction: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. Objective: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. Methods: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. Results: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. Conclusion: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription (AU)

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y ácido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y ácido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea (AU)

The Mediterranean diet and micronutrient levels in depressive patients.

INTRODUCTION: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. OBJECTIVE: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. METHODS: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. RESULTS: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. CONCLUSION: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription.

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y acido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y acido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea.