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1.
Ideggyogy Sz ; 74(3-4): 87-98, 2021 Mar 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33938670

RESUMO

Background and purpose: The revised Adult Attachment Scale (AAS) developed by N. L. Collins is a widely used questionnaire to measure adult attachment. However, its psychometric properties have not been investigated in Hungary. We aimed to confirm the key psychometric properties of the Hungarian version of the AAS focusing on reliability indices on a population that consis-ted of depressed and non-depressed young adults. Methods: The AAS is a self-report questionnaire, in which two different dimensional evaluating systems are possible: the original (close, depend, and anxiety) and the alternative scoring system (anxiety, avoidance). Our study population consisted of young adults with a history of major depression (n = 264, median age = 25.7 years) and their never-depressed biological siblings (n = 244, median age = 24.0). Results: The internal consistency of close, anxiety, and avoidance scales were satisfactory (Cronbach-α >0.7). The consistency of the depend scale was slightly lower than expected (Cronbach-α = 0.62). Test-retest reliability was good for all of the scales, it ranged from 0.73 to 0.78 after 14 months of follow-up period. The scale showed good discrimination as tested by the differences of close and anxiety attachment dimensions between the groups (p<0.01). More-over, we were able to differentiate the currently dep-res-sed subjects based on these attachment dimensions. Explo-ra-tory and confirmatory factor analyses were conducted, and a bifactor solution proved optimal model fit. Conclusion: The three dimensions of the AAS has not been confirmed. However, the close and anxiety scales of AAS were found to be adequate. Our results also indicate that attachment features correlate with major depressive episodes in adulthood.


Assuntos
Transtorno Depressivo Maior , Adulto , Análise Fatorial , Humanos , Hungria , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
2.
Medicine (Baltimore) ; 100(14): e25273, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832092

RESUMO

BACKGROUND: The optimal dose (number of pulses per session) of repetitive transcranial magnetic stimulation (rTMS), using the H-coil, in major depressive disorder (MDD) has not previously been reported. OBJECTIVE: To explore the relationship between rTMS dose and antidepressant effect, and collect data for the design of a definitive trial. METHODS: This was a double-blind, three-arm parallel-group, randomized [1:1:1], pilot trial conducted in Stockholm, Sweden (September 2014 to September 2016). The primary outcome was change in depression severity measured with the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks. Participants (n = 29) with MDD were randomized to 1000, 2000, or 4000 pulses of rTMS for 20 sessions during 4 weeks. RESULTS: At 4 weeks, the 3 treatment groups reduced the mean MADRS (95% CI) by 11.6 (4.0-19.2), 9.1 (5.0-13.3), and 11.3 (4.1-18.5) points respectively. Eleven participants met criteria for response and 10 for remission. No serious adverse events occurred. Ratings of subjective memory improved in all groups. Exploring the effect of dose and time, 4000 pulses had the largest reduction in MADRS during the first 2 weeks. A comparison of change in MADRS between 2000 and 4000 pulses after 2 weeks will require a sample size of 66 patients at power .80 and alpha .05. CONCLUSIONS: It is feasible to conduct a definitive trial investigating whether a higher number of magnetic pulses per treatment session gives a more rapid antidepressive response.


Assuntos
Transtorno Depressivo Maior/terapia , Estimulação Magnética Transcraniana/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica
3.
Adv Exp Med Biol ; 1305: 333-349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834408

RESUMO

Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved technique for treating medication-resistant depression. Conventional rTMS includes high frequency (HF) to left dorsolateral prefrontal cortex (DLPFC) and low frequency to right DLPFC. However, not all depressed patients could benefit from standard rTMS protocols. Meta-analytical evidence indicated that there was an average response rate of 29.3% for patients receiving the most commonly adopted HF rTMS to the left DLPFC. Hence, newer forms of rTMS paradigms are warranted to improve antidepressant response and remission rate in patients with depression, especially those who are refractory to adequate antidepressant trials. In the current chapter, we review newer forms of rTMS paradigms and the content will cover standard theta burst stimulation (TBS), prolonged iTBS (piTBS), accelerated rTMS (aTMS), deep TMS (dTMS), priming TMS (pTMS), synchronized TMS (sTMS), and magnetic seizure therapy (MST).


Assuntos
Transtorno Depressivo Maior , Estimulação Magnética Transcraniana , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Córtex Pré-Frontal , Resultado do Tratamento
4.
Adv Exp Med Biol ; 1305: 449-461, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834412

RESUMO

Major depressive disorder carries a significant burden and a high risk for suicide. The need for more effective, safer, and faster-acting drugs is, therefore, compelling. The present chapter briefly assesses the most promising agents, focusing on non-monoamine-targeting compounds, namely, the glutamate antagonist ketamine and its enantiomer esketamine. A critical overview of the evidence and the pitfalls associated with current antidepressant drug development is likewise provided in the following text.


Assuntos
Transtorno Depressivo Maior , Psicofarmacologia , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios , Humanos
5.
Adv Exp Med Biol ; 1305: 515-533, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834416

RESUMO

The volume of research on the therapeutic use of psychedelic drugs has been increasing during the last decades. Partly because of the need of innovative treatments in psychiatry, several studies have assessed the safety and efficacy of drugs like psilocybin or ayahuasca for a wide range of mental disorders, including major depression. The first section of this chapter will offer an introduction to psychedelic research, including a brief historical overview and discussions about appropriate terminology. In the second section, the recently published clinical trials in which psychedelic drugs were administered to patients will be analysed in detail. Then, in the third section, the main neurobiological mechanisms of these drugs will be described, noting that while some of these mechanisms could be potentially associated with their therapeutic properties, they are commonly used as adjuvants in psychotherapeutic processes. The last section suggests future challenges for this groundbreaking field of research and therapy.


Assuntos
Transtorno Depressivo Maior , Alucinógenos , Psiquiatria , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Alucinógenos/uso terapêutico , Humanos , Psilocibina/uso terapêutico
6.
Adv Exp Med Biol ; 1305: 3-18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834391

RESUMO

Phenotype networks enable clinicians to elucidate the patterns of coexistence and interactions among the clinical symptoms, negative cognitive styles , neurocognitive performance, and environmental factors in major depressive disorder (MDD). Results of phenotype network approach could be used in finding the target symptoms as these are tightly connected or associated with many other phenomena within the phenotype network of MDD specifically when comorbid psychiatric disorder(s) is/are present. Further, by comparing the differential patterns of phenotype networks before and after the treatment, changing or enduring patterns of associations among the clinical phenomena in MDD have been deciphered.Brain structural covariance networks describe the inter-regional co-varying patterns of brain morphologies, and overlapping findings have been reported between the brain structural covariance network and coordinated trajectories of brain development and maturation. Intra-individual brain structural covariance illustrates the degrees of similarities among the different brain regions for how much the values of brain morphological features are deviated from those of healthy controls. Inter-individual brain structural covariance reflects the degrees of concordance among the different brain regions for the inter-individual distribution of brain morphologic values. Estimation of the graph metrics for these brain structural covariance networks uncovers the organizational profile of brain morphological variations in the whole brain and the regional distribution of brain hubs.


Assuntos
Transtorno Depressivo Maior , Encéfalo/diagnóstico por imagem , Depressão , Transtorno Depressivo Maior/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Vias Neurais , Fenótipo
7.
Adv Exp Med Biol ; 1305: 19-33, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834392

RESUMO

This chapter will focus on task magnetic resonance imaging (MRI) to understand the biological mechanisms and pathophysiology of brain in major depressive disorder (MDD), which would have minor alterations in the brain function. Therefore, the functional study, such as task MRI functional connectivity, would play a crucial role to explore the brain function in MDD. Different kinds of tasks would determine the alterations in functional connectivity in task MRI studies of MDD. The emotion-related tasks are linked with alterations in anterior cingulate cortex, insula, and default mode network. The emotional memory task is linked with amygdala-hippocampus alterations. The reward-related task would be related to the reward circuit alterations, such as fronto-straital. The cognitive-related tasks would be associated with frontal-related functional connectivity alterations, such as the dorsolateral prefrontal cortex, anterior cingulate cortex, and other frontal regions. The visuo-sensory characteristics of tasks might be associated with the parieto-occipital alterations. The frontolimbic regions might be major components of task MRI-based functional connectivity in MDD. However, different scenarios and tasks would influence the representations of results.


Assuntos
Transtorno Depressivo Maior , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Depressão , Transtorno Depressivo Maior/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética
8.
Adv Exp Med Biol ; 1305: 35-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834393

RESUMO

Major depressive disorder (MDD) is frequently characterized as a disorder of the disconnection syndrome. Diffusion tensor imaging (DTI) has played a critical role in supporting this view, with much investigation providing a large amount of evidence of structural connectivity abnormalities in the disorder. Recent research on the human connectome combined neuroimaging techniques with graph theoretic methods to highlight the disrupted topological properties of large-scale structural brain networks under depression, involving global metrics (e.g., global and local efficiencies), and local nodal properties (e.g., degree and betweenness), as well as other related metrics, including a modular structure, assortativity, and (rich) hubs. Here, we review the studies of white matter networks in the case of MDD with the application of these techniques, focusing principally on the consistent findings and the clinical significance of DTI-based network research, while discussing the key methodological issues that frequently arise in the field. The already published literature shows that MDD is associated with a widespread structural connectivity deficit. Topological alteration of structural brain networks in the case of MDD points to decreased overall connectivity strength and reduced global efficiency as well as decreased small-worldness and network resilience. These structural connectivity disturbances entail potential functional consequences, although the relationship between the two is very sophisticated and requires further investigation. In summary, the present study comprehensively maps the structural connectomic disturbances in patients with MDD across the entire brain, which adds important weight to the view suggesting connectivity abnormalities of this disorder and highlights the potential of network properties as diagnostic biomarkers in the psychoradiology field. Several common methodological issues of the study of DTI-based networks are discussed, involving sample heterogeneity and fiber crossing problems and the tractography algorithms. Finally, suggestions for future perspectives, including imaging multimodality, a longitudinal study and computational connectomics, in the further study of white matter networks under depression are given. Surmounting these challenges and advancing the research methods will be required to surpass the simple mapping of connectivity changes to illuminate the underlying psychiatric pathological mechanism.


Assuntos
Transtorno Depressivo Maior , Substância Branca , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Depressão , Transtorno Depressivo Maior/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Estudos Longitudinais , Vias Neurais/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
9.
Adv Exp Med Biol ; 1305: 57-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834394

RESUMO

Major depressive disorder (MDD) shows a high prevalence and is associated with increased disability. While traditional studies aimed to investigate global characteristic neurobiological substrates of MDD, machine learning-based approaches focus on individual people rather than a group. Therefore, machine learning has been increasingly conducted and applied to clinical practice. Several previous neuroimaging studies used machine learning for stratifying MDD patients from healthy controls as well as in differentially diagnosing MDD apart from other psychiatric disorders. Also, machine learning has been used to predict treatment response using magnetic resonance imaging (MRI) results. Despite the recent accomplishments of machine learning-based MRI studies, small sample sizes and the heterogeneity of the depression group limit the generalizability of a machine learning-based predictive model. Future neuroimaging studies should integrate various materials such as genetic, peripheral, and clinical phenotypes for more accurate predictability of diagnosis and treatment response.


Assuntos
Transtorno Depressivo Maior , Encéfalo/diagnóstico por imagem , Depressão , Transtorno Depressivo Maior/diagnóstico por imagem , Humanos , Aprendizado de Máquina , Imagem por Ressonância Magnética , Neuroimagem
10.
Adv Exp Med Biol ; 1305: 71-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834395

RESUMO

The aim of this contribution is to introduce Spatiotemporal Psychopathology and the way it may complement and extent Phenomenological Psychopathology by bridging the methodological gap between the brain and experience. In the first part, I will provide examples for spatiotemporal correspondence between neuronal and psychopathological features. Specifically, I will discuss how spatial changes in the brain's spontaneous activity translate into abnormal experience of the self in major depressive disorder (MDD). Finally, I will briefly discuss the method of such Spatiotemporal Psychopathology and distinguish it from the methods relied on in other forms of Psychopathology with a special focus on showing the continuity between Spatiotemporal and Phenomenological Psychopathology.


Assuntos
Transtorno Depressivo Maior , Psicopatologia , Encéfalo , Depressão , Humanos
11.
Adv Exp Med Biol ; 1305: 85-99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834396

RESUMO

A leading goal in the field of biological psychiatry for depression is to find a promising diagnostic biomarker and selection of specific psychiatric treatment mode that is most likely to benefit patients with depression. Recent neuroimaging studies have characterized the pathophysiology of major depressive disorder (MDD) with functional and structural alterations in the neural circuitry involved in emotion or reward processing. Particularly, structural and functional magnetic resonance imaging (MRI) studies have reported that the brain structures deeply involved in emotion regulation or reward processing including the amygdala, prefrontal cortex (PFC), anterior cingulate cortex (ACC), ventral striatum, and hippocampus are key regions that provide useful information about diagnosis and treatment outcome prediction in MDD. For example, it has been consistently reported that elevated activity of the ACC is associated with better antidepressant response in patients with MDD. This chapter will discuss a growing body of evidence that suggests that diagnosis or prediction of outcome for specific treatment can be assisted by a neuroimaging-based biomarker in MDD.


Assuntos
Transtorno Depressivo Maior , Biomarcadores , Encéfalo/diagnóstico por imagem , Depressão , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Córtex Pré-Frontal
12.
Adv Exp Med Biol ; 1305: 103-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834397

RESUMO

The Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) was revised based on a combination of a categorical and a dimensional approach such that in the DSM, Fifth Edition (DSM-5), depressive disorders have been separated as a distinctive disease entity from bipolar disorders, consistent with the deconstruction of Kraepelinian dualism. Additionally, the diagnostic thresholds of depressive disorders may be reduced due to the addition of "hopelessness" to the subjective descriptors of depressed mood and the removal of the "bereavement exclusion." Manic/hypomanic, psychotic, and anxious symptoms in major depressive disorder (MDD) and other depressive disorders are described using the transdiagnostic specifiers of "with mixed features," "with psychotic features," and "with anxious distress," respectively. Additionally, due to the polythetic and operational characteristics of the DSM-5 diagnostic criteria, the heterogeneity of MDD is inevitable. Thus, 227 different symptom combinations fulfill the DSM-5 diagnostic criteria for MDD. This heterogeneity of MDD is criticized in view of the Wittgensteinian analogy of language game. Depression subtypes determined by disturbances in monoamine levels and the severity of the disease have been identified in the literature. According to a review of the Gottesman and Gould criteria, neuroticism, morning cortisol, cortisol awakening response, asymmetry in frontal cortical activity on electroencephalography (EEG), and probabilistic reward learning, among other variables, are evidenced as endophenotypes for depressive disorders. Network analysis has been proposed as a potential method to compliment the limitations of current diagnostic criteria and to explore the pathways between depressive symptoms, as well as to identify novel and interesting relationships between depressive symptoms. Based on the literature on network analysis in this field, no differences in the centrality index of the DSM and non-DSM symptoms were repeatedly present among patients with MDD. Furthermore, MDD and other depressive syndromes include two of the Research Domain Criteria (RDoC), including the Loss construct within the Negative Valence Systems domains and various Reward constructs within the Positive Valence Systems domain.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Transtornos Psicóticos , Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Padrões de Referência
13.
Adv Exp Med Biol ; 1305: 157-173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834400

RESUMO

The neurochemical model of depression, based on monoaminergic theories, does not allow on its own to understand the mechanism of action of antidepressants. This approach does not explain the gap between the immediate biochemical modulations induced by antidepressants and the time required for their clinical action. Several hypotheses have been developed to try to explain more precisely the action of these molecules, each of them involving mechanisms of receptor regulation. At the same time, data on the neuroanatomy of depression converge toward the existence of specific lesions of this pathology. This chapter aims to provide an overview of recent advances in understanding the mechanisms of neural plasticity involved in pathophysiology depression and in its treatment.


Assuntos
Transtorno Depressivo Maior , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Hipocampo , Humanos , Neurogênese , Plasticidade Neuronal
14.
Adv Exp Med Biol ; 1305: 129-155, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834399

RESUMO

In the last three decades, the robust scientific data emerged, demonstrating that the immune-inflammatory response is a fundamental component of the pathophysiology of major depressive disorder (MDD). Psychological stress and various inflammatory comorbidities contribute to such immune activation. Still, this is not uncommon that patients with depression do not have defined inflammatory comorbidities, and alternative mechanisms of immune activation need to take place. The gastrointestinal (GI) tract, along with gut-associated lymphoid tissue (GALT), constitutes the largest lymphatic organ in the human body and forms the biggest surface of contact with the external environment. It is also the most significant source of bacterial and food-derived antigenic material. There is a broad range of reciprocal interactions between the GI tract, intestinal microbiota, increased intestinal permeability, activation of immune-inflammatory response, and the CNS that has crucial implications in brain function and mental health. This intercommunication takes place within the microbiota-gut-immune-glia (MGIG) axis, and glial cells are the main orchestrator of this communication. A broad range of factors, including psychological stress, inflammation, dysbiosis, may compromise the permeability of this barrier. This leads to excessive bacterial translocation and the excessive influx of food-derived antigenic material that contributes to activation of the immune-inflammatory response and depressive psychopathology. This chapter summarizes the role of increased intestinal permeability in MDD and mechanisms of how the "leaky gut" may contribute to immune-inflammatory response in this disorder.


Assuntos
Transtorno Depressivo Maior , Microbioma Gastrointestinal , Comunicação , Depressão , Humanos , Neuroglia , Neurônios
15.
Adv Exp Med Biol ; 1305: 175-202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834401

RESUMO

Depression is heterogeneous and complex disease with diverse symptoms. Its neurobiological underpinning is still not completely understood. For now, there are still no validated, easy obtainable, clinically useful noninvasive biomarker(s) or biomarker panel that will be able to confirm a diagnosis of depression, its subtypes and improve diagnostic procedures. Future multimodal preclinical and clinical research that involves (epi)genetic, molecular, cellular, imaging, and other studies is necessary to advance our understanding of the role of monoamines, GABA, HPA axis, neurotrophins, metabolome, and glycome in the pathogenesis of depression and their potential as diagnostic, prognostic, and treatment response biomarkers. These studies should be focused to include the first-episode depression and antidepressant drug-naïve patients with large sample sizes to reduce variability in different biological and clinical parameters. At present, metabolomics study revealed with high precision that a neurometabolite panel consisting of plasma metabolite biomarkers (GABA, dopamine, tyramine, kynurenine) might represent clinically useful biomarkers of MDD.


Assuntos
Transtorno Depressivo Maior , Sistema Hipotálamo-Hipofisário , Biomarcadores , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Humanos , Sistema Hipófise-Suprarrenal
16.
Adv Exp Med Biol ; 1305: 231-255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834403

RESUMO

Genetic factors play a significant but complex role in antidepressant (AD) response and tolerability. During recent years, there is growing enthusiasm in the promise of pharmacogenetic/pharmacogenomic (PGx) tools for optimizing and personalizing treatment outcomes for patients with major depressive disorder (MDD). The influence of pharmacokinetic and pharmacodynamic genes on response and tolerability has been investigated, including those encoding the cytochrome P450 superfamily, P-glycoprotein, monoaminergic transporters and receptors, intracellular signal transduction pathways, and the stress hormone system. Genome-wide association studies are also identifying new genetic variants associated with AD response phenotypes, which, combined with methods such as polygenic risk scores (PRS), is opening up new avenues for novel personalized treatment approaches for MDD. This chapter describes the basic concepts in PGx of AD response, reviews the major pharmacokinetic and pharmacodynamic genes involved in AD outcome, discusses PRS as a promising approach for predicting AD efficacy and tolerability, and addresses key challenges to the development and application of PGx tests.


Assuntos
Transtorno Depressivo Maior , Farmacogenética , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/genética , Estudo de Associação Genômica Ampla , Humanos
17.
Adv Exp Med Biol ; 1305: 257-272, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834404

RESUMO

According to the neurotrophic hypothesis of major depressive disorder (MDD), impairment in growth factor signaling might be associated with the pathology of this illness. Current evidence demonstrates that impaired neuroplasticity induced by alterations of neurotrophic growth factors and related signaling pathways may be underlying to the pathophysiology of MDD. Brain-derived neurotrophic factor (BDNF) is the most studied neurotrophic factor involved in the neurobiology of MDD. Nevertheless, developing evidence has implicated other neurotrophic factors, including neurotrophin-3 (NT-3), neurotrophin-4 (NT-4), nerve growth factor (NGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), glial cell-derived neurotrophic factor (GDNF), and fibroblast growth factor (FGF) in the MDD pathophysiology. Here, we summarize the current literature on the involvement of neurotrophic factors and related signaling pathways in the pathophysiology of MDD.


Assuntos
Transtorno Depressivo Maior , Fator Neurotrófico Derivado do Encéfalo/genética , Transtorno Depressivo Maior/tratamento farmacológico , Fator Neurotrófico Derivado de Linhagem de Célula Glial , Humanos , Transdução de Sinais , Fator A de Crescimento do Endotélio Vascular
18.
Adv Exp Med Biol ; 1305: 311-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834407

RESUMO

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Atenção Plena , Adulto , Transtorno Depressivo Maior/terapia , Humanos , Resolução de Problemas , Resultado do Tratamento
19.
Adv Exp Med Biol ; 1305: 429-445, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834411

RESUMO

Major depressive disorder (MDD) is one of the leading causes of disability worldwide, and a considerable portion of depressed patients does not respond well to available treatment strategies. Algorithm-based treatment may contribute to improving the MDD outcomes and have the potential to homogenize the pharmacological treatment of MDD patients, facilitating outcome research and cost-effectiveness analysis. This chapter provides a critical review of the available literature on the use of treatment algorithms for the management of MDD. The main available algorithms, their effectiveness, and challenges and limitations associated with their development are discussed. Finally, we provide a discussion of the future direction of algorithm-based treatments for MDD.


Assuntos
Transtorno Depressivo Maior , Psicofarmacologia , Algoritmos , Análise Custo-Benefício , Transtorno Depressivo Maior/tratamento farmacológico , Humanos
20.
Adv Exp Med Biol ; 1305: 375-427, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33834410

RESUMO

Complementary and alternative medicine (CAM) encompasses a wide range of different non-mainstream therapies that have been increasingly used for treatment or adjunctive treatment of various ailments with mood disorders and "depressive difficulties" being two of the commonly CAM (self-)medicated conditions. We focus specifically on clinically diagnosed (in line with the standard criteria) depressive disorders, primarily major depressive disorder (MDD), and overview evidence of efficacy/safety of a range of CAM modalities addressing exclusively randomized controlled trials (RCTs) and systematic reviews/meta-analyses of RCTs. The list of addressed CAM interventions is not exhaustive: due to space limitation, addressed are interventions with at least a few conducted RCTs in the specific clinical conditions. We try to provide numerical and meaningful data as much as it is possible and to (a) indicate situations in which the reported data/estimates might have been "too enthusiastic" and (b) warn about heterogeneity of results that, together with other possible limitations (various biases and imprecision), results in uncertainty about the effects.


Assuntos
Terapia por Acupuntura , Terapias Complementares , Transtorno Depressivo Maior , Transtorno Depressivo Maior/terapia , Humanos
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