Natural volatile oils derived from herbal medicines: A promising therapy way for treating depressive disorder.

Depression is a common global mental disorder that seriously harms human physical and mental health. With the development of society, the increase of pressure and the role of various other factors make the incidence of depression increase year by year. However, there is a lack of drugs that have a fast onset, significant effects, and few side effects. Some volatile oils from traditional natural herbal medicines are usually used to relieve depression and calm emotions, such as Lavender essential oil and Acorus tatarinowii essential oil. It was reported that these volatile oils, are easy to enter the brain through the blood-brain barrier and have good antidepressant effects with little toxicity and side effects. In this review, we summarized the classification of depression, and listed the history of using volatile oils to fight depression in some countries. Importantly, we summarized the anti-depressant natural volatile oils and their monomers from herbal medicine, discussed the anti-depressive mechanisms of the volatile oils from natural medicine. The volatile oils of natural medicine and antidepressant drugs were compared and analyzed, and the application of volatile oils was explained from the clinical use and administration routes. This review would be helpful for the development of potential anti-depressant medicine and provide new alternative treatments for depressive disorders.

[Network analyses: Are we moving toward a new conceptualization and treatment of mental disorder?] / Les analyses par réseau : vers une nouvelle conceptualisation et prise en charge des troubles mentaux ?

In a break with categorical and dimensional approaches and thus the classical medical model, the network approach applied to psychopathology constitutes a holistic approach to mental disorders. In this approach, mental disorders are conceived as an interconnected system of symptoms in which symptoms are the cause of each other. It is suggested that the interaction between the different symptoms would result in a feedback loop that leads to the installation and maintenance of these symptoms/disorders. In addition, this approach proposes that co-morbidities are the result of symptom-symptom interactions that cross the diagnostic boundary and interact with symptoms from other psychiatric disorders. A growing number of studies have applied the network approach to elucidate causal interactions within the symptoms of depression, post-traumatic stress disorder, schizophrenia, or anxiety disorders. The overall objective of this review is to raise awareness among researchers and clinicians in psychiatry and clinical psychology of the network approach applied to psychopathology. To do this, we present the main concepts and principles of the network approach and its application in post-traumatic stress disorder. We also discuss recent criticisms of this approach and its clinical applications.

Comparison of guidelines for the treatment of unipolar depression: a focus on pharmacotherapy and neurostimulation.

OBJECTIVE: To determine the level of agreement across a set of evidence-based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments. METHOD: A literature search was undertaken using the terms 'depression', 'depressive' and 'guidelines', using PubMed, Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Twelve national psychiatric or professional guideline-producing organizations were identified from the period 2007-2017, with guidelines qualitatively reviewed by two assessors. RESULTS: For major depressive disorder (MDD), there was general consensus to use an antidepressant (AD) in cases of greater severity, although disagreement on AD use in mild to moderate depression. There was some agreement on choice of AD class in first-line treatment recommendations, though great variability in second- and third-line management particularly in recommended augmentation and combined AD strategies. Electroconvulsive therapy was considered in all but one guideline, with other neurostimulation treatments being less consistently covered and with variable recommendations. Finally, there was low consistency in the management of dysthymia, persistent depressive disorder and treatment resistant depression. CONCLUSION: Our review identifies varying levels of consistency in guideline recommendations. Strategies to improve reliability in guideline formulation should also improve their validity.

Discovering symptom co-occurrence patterns from 604 cases of depressive patient data using latent tree models.

OBJECTIVES: In order to treat depressive patients using Traditional Chinese Medicine (TCM), it is necessary to classify them into subtypes from the TCM perspective. Those subtypes are called Zheng types. This article aims at providing evidence for the classification task by discovering symptom co-occurrence patterns from clinic data. METHODS: Six hundred four (604) cases of depressive patient data were collected. The subjects were selected using the Chinese classification of mental disorder clinic guideline CCMD-3. The symptoms were selected based on the TCM literature on depression. The data were analyzed using latent tree models (LTMs). RESULTS: An LTM with 29 latent variables was obtained. Each latent variable represents a partition of the subjects into 2 or more clusters. Some of the clusters capture probabilistic symptom co-occurrence patterns, while others capture symptom mutual-exclusion patterns. Most of the co-occurrence patterns have clear TCM Zheng connotations. CONCLUSIONS: From clinic data about depression, probabilistic symptom co-occurrence patterns have been discovered that can be used as evidence for the task of classifying depressive patients into Zheng types.

[Atypical depression: Clinical perspectives]. / La dépression atypique : perspectives cliniques.

OBJECTIVE: This paper examines whether atypical depression is still a valid entity as a diagnosis subtype in the light of publications with most recent antidepressants. METHOD: First, we present the origins of the diagnosis sub-specification of atypical depression, which is based on a different drug response to tricyclic antidepressants and mono amino oxydase inhibitors. Secondly, we discuss the different definitions that can be found for the terms of atypical depression. We present more specifically the definition of atypical depression as it is described in the DSM-IV, with its most important criterion: mood reactivity. Then we present a review of scientific publications questioning atypical depression validity as a clinical syndrome (based on medline researches). We will see whether this diagnosis is still relevant with the latest drugs used to treat mood disorders. A special focus is made on the link between atypical depression and bipolar disorder, based on Benazzi's work. RESULTS: Most of publications confirm that atypical depression is a valid syndrome regarding first antidepressants clinical trials. Nevertheless, more studies with the latest antidepressants and atypical antipsychotics are needed to confirm this hypothesis. The link between atypical depression and bipolar disorders seems to be quite strong although it requires further investigations. DISCUSSION: There are very few double-blind drug trials focusing on atypical depressions and results need to be confirmed by trials with new drugs. Moreover, we regret that there are no studies including cerebral imagery. More studies are also needed on neurobiology and psychotherapy specificity. CONCLUSION: Atypical depression is still a useful concept, because of its specific clinical presentation, evolution and treatments, even if more studies should be done. Atypical depression could also be useful to diagnose more easily some bipolar disorders and should help clinicians to focus more on suicidal risks and addiction evaluation for these patients, considering the mood reactivity and the link with bipolar disorder. To conclude, we propose that atypical depression should still figure in the future DSM-V for these different reasons.

[F45.41: chronic pain disorder with somatic and psychological factors : a coding aid]. / F45.41 Chronische Schmerzstörung mit somatischen und psychischen Faktoren : Eine Kodierhilfe.

In 2009, the German version of ICD-10 (ICD-10 GM version 2009) introduced the diagnosis of "chronic pain disorder with somatic and psychological factors", because current ICD-10 diagnoses did not address the biopsychosocial character of chronic pain adequately. For most patients, a dichotomous classification into psychologically versus biomedically caused pain is inappropriate and does not reflect current knowledge on pain. The new code F45.41 addresses the relevance of psychological factors for chronic pain persistence and chronic pain treatment, even in those conditions with a clear biomedical cause at the beginning. This guideline describes how to use this new diagnosis, which boundaries have to be considered, and how comorbid and associated conditions can be classified. The distinction of this new diagnosis from other pain-associated diagnoses and recommendations for the coding of comorbid conditions are presented. The differentiation of everyday pain symptoms from pain disorders is outlined. Finally, contextual factors of the classification process, as well as problems in integrating this new diagnosis into diagnosis-related group (DRG) systems of financial reimbursement are discussed.

[Depressive disorders in a globalizing world: issues for psychiatric diagnosis]. / Troubles dépressifs dans un monde globalisé: enjeux pour le diagnostic psychiatrique.

We review the literature addressing psychiatric assessment in a globalizing world, with an emphasis on depressive disorders. After a presentation of the current stakes in the game of migration, we will explore the quandary concerning psychiatric classifications and their validity in transcultural situations. The treatment of culture in the DSM-IV (American classification system) and the ICD-10 (WHO classification system) will be discussed. Despite differences of symptomatic presentation and explanatory models of illness, depressive disorders are encountered everywhere, but the consequences for the individual may vary from one cultural context to another one. Therefore, psychiatric evaluation should be integrated into a holistic diagnostic formulation.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care.

These practical guidelines for the biological treatment of unipolar depressive disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the treatment of unipolar depressive disorders and offer practical recommendations for general practitioners encountering patients with these conditions. The guidelines cover disease definition, classification, epidemiology and course of unipolar depressive disorders, and the principles of management in the acute, continuation and maintenance phase. They deal primarily with biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy).

[Cognitive impairment: classification by proton magnetic resonance spectroscopy and the contributions of conventional magnetic resonance imaging]. / Deterioro cognitivo: clasificación mediante espectroscopia de resonancia magnética de protón y contribución de la imagen convencional.

OBJECTIVE: To analyze the diagnostic accuracy of proton magnetic resonance spectroscopy (1H MRS) in patients with cognitive impairment and to establish the usefulness of complementary information provided by conventional magnetic resonance imaging (MRI). MATERIAL AND METHODS: 64 patients with cognitive impairment, including Alzheimer's disease (AD) (n=31), vascular dementia (n=6), mild cognitive impairment (MCI) (n=9), and major depression (n=18), were studied. All patients underwent cerebral MRI and single-volume 1H MRS using two echo times (TE, 31 and 136 ms) in the posterior cingulate gyrus and right temporal lobe. The metabolites analyzed were N-acetylaspartate (NAA), myo-Inositol (mI), choline (Ch), and creatine (Cr), and the ratios of Ch/Cr, mI/Cr, NAA/mI and NAA/Cr were calculated. In order to differentiate among the different types of cognitive impairment, the alterations in imaging and spectroscopy findings were graded from 0 to 4, as was the mean combination of the two, and then ROC curves were obtained. RESULTS: Statistically significant differences were found between the spectra of patients with dementia (AD and vascular dementia) and those without dementia (MCI and depression) in the posterior cingulate gyrus. The NAA/mI ratio yielded the best area under the ROC curve, with the best sensitivity (82.5%) and specificity (72.7%) in the diagnosis of AD. The NAA/mI and mI/Cr quotients differentiated between the four degenerative pathologies causing the cognitive impairment. The combination of MRI and 1H MRS significantly improved the accuracy of the diagnosis of AD. CONCLUSIONS: The metabolic differences found among patients with cognitive impairment using 1H MRS can be useful for differentiating AD, vascular dementia, MCI, and depression. The combination of spectroscopy and MRI findings is useful in the diagnosis of AD.

Improving depression treatment by integrated care.

OBJECTIVE: To identify the clinical and economic implications of depression in the workplace and review how integrated care models can improve overall patient outcomes. SUMMARY: Depression is a significant financial burden to the employer due to lost days of work and decreased productivity. Employers are demanding return on the investment for their increasing health care expenditures. The cost of depression to employers may be contained by delivering care using integrated models that leverage primary care provider treatment with care management and mental health consultation. CONCLUSION: There is a need to reduce silos in the organization and financing of mental health care to prevent cost shifting that provides no benefit to patients, payers or providers. Poor mental health care will likely lead to a rise in absenteeism and presenteeism.

Altered habituation in the auditory cortex in a subgroup of depressed patients by functional magnetic resonance imaging.

The aim of this study was to measure and quantify habituation effects to auditory stimulation within the auditory cortex of 11 depressed patients with major depressive disorder compared to 11 healthy subjects. Habituation was visualized by functional magnetic resonance imaging (fMRI) employing a block design (repeated stimulation with sine tones). A subgroup of patients (n = 5) presented the following abnormal habituation fMRI pattern: significantly lower activation after the first stimulation block (p = 0.05), missing characteristic signal decay to repeated acoustic stimulation and a marked undershoot after each stimulation block. This abnormal pattern may indicate functional deficits in auditory processing occurring with depression, but our results need be confirmed in a larger, more homogeneous patient group. This paradigm may be a useful tool for assessing cortical dysfunction in mood disorders.

[Diagnosis and treatment of depressive disorders in the doctor's office]. / Depression--erkennen, behandeln, vorbeugen. Was kann der Hausarzt tun?

Depression is underdiagnosed and undertreated though its high prevalence and life-threatening character. Once identified, depression can be treated successfully with antidepressants, cognitive behavior therapy/interpersonal psychotherapy or a combination of both. Regarding selection of a particular antidepressant, newer, selective drugs are preferred due to better tolerability and low toxicity.

Psicopatología y clasificación de los trastornos depresivos / Psychopathology and classification of depressive disorders

Las depresiones constituyen un grupo heterogéneo de trastornos desde los puntos de vista etiológico, sintomatológico y evolutivo, lo que ha conllevado dificultades para definir el síndrome depresivo axial y sus formas clínicas. Estas dificultades se han traducido en definiciones y sistemas nosológicos cambiantes a lo largo del tiempo, así como en dificultades para delimitar los trastornos depresivos de variaciones afectivas de la normalidad y de otros trastornos mentales con síntomas depresivos. En este estudio, partiendo de la distinción entre alteraciones de los sentimientos y del humor, se propone una definición del síndrome depresivo axial. Se analizan las características de las clasificaciones categoriales y dimensionales en términos de su idoneidad para clasificar los trastornos depresivos. Aunque ambas aproximaciones tienen pros y contras, la aproximación dimensional parece tener más validez para clasificar los trastornos mentales en general y los depresivos en particular. Se propone un modelo de clasificación multidimensional de las depresiones que integra los planos etiológico, psicopatológico y evolutivo, los cuales se componen a su vez de subdimensiones relevantes desde el punto de vista clínico y terapéutico (AU)

Assessment of psychological distress in the setting of medical disease.

The biopsychosocial model of disease has recently been depicted as the basis for a renewed emphasis on the multiaxial diagnostic system of the DSM-IV. The authors challenge this stance, underscoring the clinical inadequacies of the DSM-IV in the setting of medical disease, particularly the chapters concerned with somatoform disorders and psychological factors affecting medical conditions. Diagnostic criteria which are based on the clinical insights derived from psychosomatic research in the past decades may offer new opportunities to psychosomatic medicine and consultation-liaison psychiatry. The development of the Diagnostic Criteria for Psychosomatic Research (DCPR), encompassing alexithymia, type A behavior, irritable mood, demoralization, disease phobia, thanatophobia, health anxiety, illness denial, functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction, is described. Preliminary results obtained with the combination of DSM and DCPR criteria appear to be promising.

Depressive illness and Navajo healing.

What is the experience of Navajo patients in Navajo religious healing who, by the criteria and in the vernacular of contemporary psychiatry, would be diagnosed with the disorder called depression? We ask this question in the context of a double dialogue between psychiatry and anthropology and between these disciplines' academic constructs of illness and those of contemporary Navajos. The dialogue is conducted in the arena of patient narratives, providing a means for observing and explicating processes of therapeutic change in individuals, for illustrating variations in forms of Navajo religious healing sought out by patients demonstrating similar symptoms of distress, and for considering the heuristic utility of psychiatric diagnoses and nomenclature in the conceptualization of illness, recovery, and religious healing. From among the 37 percent of patients participating in the Navajo Healing Project who had a lifetime history of a major depressive illness, three are discussed herein, their selection based on two criteria: (1) all met formal psychiatric diagnostic criteria for a major depressive episode at the time of their healing ceremonies, and (2) together, their experiences illustrate the range of contemporary Navajo religious healing, including Traditional, Native American Church (NAC), and Christian forms. We suggest that, despite the explicit role of the sacred in religious healing interventions available to Navajo patients, differences between biomedical and religious healing systems may be of less significance than their shared existential engagement of problems such as those glossed as depression.

Depression subtyping: treatment implications.

The complexity of subtyping depression and the implications that such subtyping has on treatment choices are discussed in this article. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) directs clinicians to classify the mood disorders in depressed patients as unipolar, bipolar, due to a general medical condition, or due to substance abuse. The focus of this article is unipolar (major depression and dysthymia) and bipolar I and II disorders with and without feature specifiers for atypical depression, seasonal affective disorder, psychotic depression, and postpartum depression. Anxious depression, which is not a DSM-IV classification, is also reviewed.

St John's Wort (Hypericum perforatum)--a herbal antidepressant.

A number of clinical studies conducted over the past few years have indicated that whole extract of St John's wort (Hypericum perforatum L.) has antidepressant effects. The herbal antidepressant St John's wort offers promising results in the treatment of patients with mild and moderate depression (response rate of 60-70% estimated by analysis of pooled data). St John's wort preparations are well tolerated. Their use rarely leads to adverse drug reactions which, when they do occur, are mainly subjective symptoms (e.g. gastrointestinal, dizziness). The generally good tolerability of St John's wort preparations and the resulting high patient compliance in taking the prescribed medication, in conjunction with their efficacy in mild and moderate depression, make these preparations particularly suitable for use in outpatient practice. Tolerability is also very good in elderly patients. If a sufficiently high-dose course of treatment with St John's wort preparations (900 mg daily) does not lead to a clear improvement in depression after four to six weeks, therapy should be continued with an established ('classical') antidepressant.