[Others physical methods in psychiatric treatment based on electromagnetic stimulation]. / Inne fizykalne metody leczenia w psychiatrii oparte o stymulacje elektromagnetyczna.

In the last decades a few new physical methods based on the electromagnetic head stimulation were subjected to the clinical research. To them belong:--vagus nerve stimulation (VNS),--magnetic seizure therapy/magnetoconvulsive therapy (MST/MCT),--deep stimulation of the brain (DBS) and--transcranial direct current stimulation (tDCS). The paper presents a description of mentioned techniques (nature, advantages, defects, restrictions), which were compared to the applied electroconvulsive treatment ECT, earlier described transcranial magnetic stimulation TMS and the pharmacotherapy (the basis of the psychiatric treatment).

Magnetic seizure therapy (MST)--a safer method for evoking seizure activity than current therapy with a confirmed antidepressant efficacy.

Since 1999, attempts have been made in the application of a new technique called magnetic seizure therapy (MST) or magnetic convulsion therapy (MCT) in the treatment of depressive disorder--as an alternative to electroconvulsive treatment. The technique of rapid rate transcranial magnetic stimulation (rTMS) is used to evoke intentional and repeated magnetoconvulsive seizures, though it requires the use of stimulation parameters practically inaccessible in commercially available rTMS magnetic stimulators. Magnetic convulsion therapy has been tested on monkeys as well as humans. A decisive majority of studies carried out both on animals and humans addressed the issue of safety of the MST method and confirmed that the side-effects (mostly of a cognitive nature) which occurred after magnetic seizures were weaker than those observed after electroconvulsive seizures. An analysis of available sources, however, does not confirm any proven antidepressant action of the MST technique. No experimental investigations have been carried out on animal models of depression. Clinical effectiveness had been confirmed in merely a few (perhaps three) patients with depression. The authors submit the results of the hitherto conducted studies on MST to critical analysis, particularly in the aspect of their antidepressant efficacy.

[Usefulness of proton MR spectroscopy for determining diagnosis and treatment outcome in unipolar depressive disorder]. / Ocena przydatnosci protonowej spektroskopii MR w diagnostyce i monitorowaniu leczenia choroby afektywnej jednobiegunowej.

PURPOSE: The aim of the study was to evaluate the usefulness of proton MR spectroscopy for determining the biochemical abnormalities in acute episode of depression and after regression of the disease in course of unipolar depressive disorder. MATERIAL AND METHODS: Forty one patients (age 18-55 years) with known unipolar depressive disorder (a Hamilton Depression Rating Scale of 16 or greater) were evaluated by the means of HMRS during acute episode of depression and after positive therapeutic response (at least 50% reduced Hamilton score for at least 4 consecutive weeks). All patients underwent single-volume 1H MRS (TR=1500 ms, TE=35 ms) using a 1.5T scanner. Four brain areas were analyzed: both frontal lobes and both hippocampi. RESULTS: In the acute fase of the disease patients had statistically significant increases in Cho/Cr levels in right hippocampus area and increases in ml/Cr levels in left frontal lobes relative to controls. After positive therapeutic response no significant abnormalities were found. CONCLUSION: These results suggest that abnormal increased brain metabolites should reverse after treatment. In the time of new imaging technics we hope that in the future 1H MRS may be helpful for determining the accuracy of the diagnosis and can improved prediction of therapeutic response in unipolar depression.

Serum zinc level in depressed patients during zinc supplementation of imipramine treatment.

BACKGROUND: Recurrent major depression is associated with decreased blood zinc concentrations that may be increased by effective antidepressant therapy. Some clinical investigations point to alterations of the zinc level in blood as a potential marker of depression. METHODS: A placebo-controlled, double blind study of zinc supplementation to imipramine therapy was conducted on sixty patients fulfilling the DSM-IV criteria for major depression (18-55 years old, 40 females, 20 males). Moreover, a group of 25 healthy volunteers was recruited (16 females, 9 males). Blood samples were drawn for the assay of serum zinc once from the control subjects and four times (before, and then 2, 6 and 12 weeks after the beginning of treatment) from the depressed subjects. RESULTS: We report that: 1) the serum zinc level was significantly lower (by 22%) in depressed patients than in healthy volunteers, 2) all groups demonstrated a gradual increase in zinc concentrations over the period of imipramine treatment with or without zinc supplementation, 3) treatment-resistant patients demonstrated lower concentrations of zinc (by 14%) than treatment-non-resistant patients, 4) zinc concentrations were higher in zinc-supplemented patients than in placebo-supplemented patients, 5) zinc supplementation increased zinc concentrations over the period of treatment, and 6) at a 12-week imipramine treatment, a significant negative correlation was demonstrated between the Montgomery-Asberg Depression Rating Scale and the serum zinc level together with a concomitant increase in serum zinc in patients in remission. CONCLUSIONS: Serum zinc is a state marker of depression.

[Computer modelling of electroconvulsive treatment and transcranial magnetic stimulation--an explanation of poor efficacy of the magnetic method]. / Komputerowe modelowanie zabiegów elektrowstrzasowych i przezczaszkowej stymulacji magnetycznej--wyjasnieni slabej skutecznosci metody magnetycznej.

With help of informatics technology it is possible to simulate various physiological processes in virtual models of biological structures. In a created realistic model of the human head we made some comparative investigations over physical phenomena accompanying the electroconvulsive treatment ECT and transcranial magnetic stimulation TMS--two methods with confirmed (ECT) or presumable (TMS) antidepressant efficacy. The present investigations are a continuation of the earlier conducted study in the simple spherical model of the head. Investigations confirmed, that magnetic stimulation TMS generates a considerably weaker current flow in the brain than it is present in electroconvulsive technique. Applying of such weak stimulation in modus,,at haphazard", i.e. on the brain area which does not need to be metabolically disturbed in this patient--cannot cause an antidepressant effect at all. The results of the investigations explain not only the safety of the magnetic method, but the weak effectiveness of this method. The authors propose some methods for improvement of TMS efficacy.

Zinc supplementation augments efficacy of imipramine in treatment resistant patients: a double blind, placebo-controlled study.

BACKGROUND: One of the main problems in the therapy of depression is the limited efficacy of antidepressants and the limited utility of augmentation strategies. Zinc, a non competitive NMDA receptor antagonist exhibits preclinical antidepressant efficacy. Moreover, a preliminary clinical report suggests augmentation of antidepressant therapy by zinc in depression. METHODS: A placebo-controlled, double blind study of zinc supplementation in imipramine therapy was conducted in sixty, 18-55-year old, unipolar depressed patients fulfilling the DSM-IV criteria for major depression without psychotic symptoms. After a one week washout period, patients were randomized into two groups treated with imipramine (approximately 140 mg/day) and receiving once daily either placebo (n=30) or zinc supplementation (n=30, 25 mgZn/day) for 12 weeks. RESULTS: No significant differences in CGI, BDI, HADRS and MADRS scores were demonstrated between zinc-supplemented and placebo-supplemented antidepressant treatment non-resistant patients. However, zinc supplementation significantly reduced depression scores and facilitated the treatment outcome in antidepressant treatment resistant patients. CONCLUSION: Zinc supplementation augments the efficacy and speed of onset of therapeutic response to imipramine treatment, particularly in patients previously nonresponsive to antidepressant pharmacotherapies. These data suggest the participation of disturbed zinc/glutamatergic transmission in the pathophysiology of drug resistance.

[Shock therapy in psychiatry--historical feature]. / Terapia wstrzasowa w psychiatrii--rys historyczny.

2008 brings the 70th anniversary of the first electroconvulsive treatment, which was applied in a Psychiatric Clinic of Rome and introduced a new physical therapy to the clinical practice. The electroconvulsive therapy (ECT)--remains as the only method from the earlier therapies practised in the era preceding modem pharmacotherapy. It survived to the present times despite some difficulties. The ECT is a safe and extremely effective method for the treatment of severe affective disorders and psychoses. The paper presents the development of ECT and others convulsive techniques in a historical context.

Effect of zinc supplementation on antidepressant therapy in unipolar depression: a preliminary placebo-controlled study.

A growing body of evidence implicates a derangement of zinc homeostasis in mood disorders. In general, unipolar depression is connected with low blood zinc levels that are increased by effective antidepressant therapy. A placebo-controlled, double blind pilot study of zinc supplementation in antidepressant therapy was conducted in patients who fulfilled DSM IV criteria for major (unipolar) depression. Patients received zinc supplementation (6 patients; 25 mg of Zn2+ once daily) or placebo (8 patients) and were treated with standard antidepressant therapy (tricyclic antidepressants, selective serotonin reuptake inhibitors). Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were used to assess efficacy of antidepressant therapy, and patients' status was evaluated before the treatment and 2, 6 and 12 weeks after its commencement. Antidepressant treatment significantly reduced HDRS scores by the 2nd week of treatment in both groups, and lowered BDI scores at the 6th week in zinc-treated group. Zinc supplementation significantly reduced scores in both measures after 6- and 12-week supplementation when compared with placebo treatment. This preliminary study is the first demonstration of the benefit of zinc supplementation in antidepressant therapy. The mechanism(s) may be related to modulation of glutamatergic or immune systems by zinc ion.