Do Adult Attachment Style or Personality Mediate the Relationship Between Childhood Maltreatment and Late-Life Depression in Poor Communities?

OBJECTIVE: Childhood maltreatment is associated with late-life depression. Preliminary evidence indicates that personality characteristics, in particular neuroticism and extroversion, and an anxious attachment style mediate this association. The objective is to evaluate 3 models, in which personality and attachment are considered mediators between childhood maltreatment and late-life depression in a socioeconomically disadvantaged Brazilian population. METHODS: This study included participants (n = 260) from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil, who completed measures of childhood maltreatment (Childhood Trauma Questionnaire - CTQ), personality characteristics (NEO-Five Factor Inventory), attachment styles (Relationship Scales Questionnaire), and geriatric depression (Mini-International Neuropsychiatric Interview-Plus). General multiple and sequential mediation analyses were used to test for possible associations. RESULTS: Attachment anxiety but not attachment avoidance is a mediator between childhood maltreatment and geriatric depression. Neuroticism is a full mediator. At that, attachment anxiety was found to be a predictor of neuroticism. Finally, sequential mediation analysis shows a path from childhood maltreatment to geriatric depression through attachment anxiety and neuroticism. CONCLUSIONS: The results suggest a pathway from childhood maltreatment to anxious attachment, which in turn predicts higher neuroticism that itself may favor late-life depression. This hypothesis could have implications for older adults living in low socioeconomic settings in that treating the high-risk group of maltreated children may help prevent late-life depression.

Efficacy and safety of antidepressant augmentation with lamotrigine in patients with treatment-resistant depression: a randomized, placebo-controlled, double-blind study.

OBJECTIVE: This study reports a clinical trial evaluating lamotrigine safety and efficacy as an antidepressant augmentation agent in treatment-resistant depression, therefore adding more empirical evidence to the limited number of studies on the use of lamotrigine. METHOD: A double-blind pilot study was conducted between March 2004 and January 2006 with 34 nonbi-polar, nonpsychotic patients who had DSM-IV major depressive disorder and were resistant to at least 2 anti-depressants. The subjects were taking antidepressant therapy and were randomly assigned to receive placebo or lamotrigine as an adjunct therapy for 8 weeks. They were evaluated on a biweekly basis in order to assess the efficacy and the safety of the drug. Efficacy was measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impressions (CGI) scale. Response was defined as a decrease of at least 50% from baseline on the MADRS and a final score ≤ 2 on the CGI. Safety was assessed by keeping record of treatment-emergent adverse events. RESULTS: The results of the adjunct treatment with lamotrigine did not reveal a significant difference according to the MADRS (p = .45). No differences between the 2 treatment groups were revealed by the repeated-measures analysis of variance or by the analysis based on the CGI (p = .45). More than 50% of the patients had been treated with at least 3 different anti-depressants. The most frequent adverse events were nausea, rash, and dyspepsia in the lamotrigine group and dizziness and headache in the placebo group. CONCLUSIONS: In this study, although it was safe, lamotrigine was not found to be an efficient augmentation agent in treatment-resistant depression. Small sample size, higher chronicity, and refractoriness may be related to treatment failure. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00652171.

An exploratory open-label trial of ziprasidone for the treatment of behavioral and psychological symptoms of dementia.

OBJECTIVE: To evaluate the efficacy and tolerability of ziprasidone in behavioral and psychological symptoms of dementia. METHOD: A 7-week open-label trial of ziprasidone. RESULTS: Of the 25 patients who participated, 15 completed the study. The main reason for discontinuation was adverse events. The mean total Neuropsychiatric Inventory (NPI) score fell significantly from 47.1 +/- 17.1 (baseline) to 25.8 +/- 17.9 (day 49) (p < 0.01). The NPI caregiver burden showed a significant improvement from 22.6 +/- 8.3 at baseline to 11.8 +/- 7.3. The most frequent adverse events were somnolence, gastrointestinal symptoms and parkinsonism. CONCLUSIONS: Ziprasidone was able to significantly improve distressing non-cognitive symptoms of dementia although adverse effects occurred. Additional large-scale, double-blind, well-controlled studies are necessary to evaluate the use of ziprasidone in this indication.

Depressão resistente a tratamento: uma revisão das estratégias farmacológicas de potencialização de antidepressivos / Treatment-resistant depression: review of pharmacologic antidepressant strategies

OBJETIVO: Fazer uma revisão sobre oito estratégias farmacológicas de potencialização de antidepressivos na DRT. MÉTODOS: Fez-se um levantamento bibliográfico de 1990 até janeiro de 2006, nas bases eletrônicas de busca Medline, LILACS e da Biblioteca Cochrane, utilizando-se os termos de busca treatment, resistant, refractory e depression e os descritores depression, drug resistance e augmentation, incluindo apenas ensaios controlados duplo-cegos. Foi consultada a referência dos artigos para obtenção de ensaios realizados em data anterior a 1990 e artigos originais de valor histórico. RESULTADOS: Foram encontrados 17 estudos duplo-cegos com o lítio, seis com o hormônio tireoidiano, dois com a buspirona, seis com o pindolol, um com a carbamazepina, dois com a lamotrigina e quatro com a olanzapina. Foram favoráveis à potencialização 41,2 por cento dos ensaios com lítio; 60 por cento daqueles com hormônio tireoidiano e antidepressivos tricíclicos e nenhum com hormônio tireoidiano e inibidores seletivos da recaptação da serotonina (ISRS); 50 por cento dos com pindolol; 100 por cento dos ensaios com carbamazepina e 40 por cento daqueles com olanzapina. Nenhum dos estudos com a buspirona foi favorável. No único estudo com lamotrigina não houve eficácia de tratamento na avaliação pelo critério principal, mas superioridade ao placebo em critérios secundários. CONCLUSÃO: Na DRT há evidência de eficácia apenas em relação ao lítio na potencialização de várias classes de antidepressivos e ao hormônio tireoidiano na potencialização de tricíclicos. A olanzapina foi razoavelmente estudada e sua eficácia não foi estabelecida. Os poucos estudos realizados com a buspirona e o pindolol não comprovaram sua eficácia. A carbamazepina foi muito pouco estudada, e a lamotrigina ainda não foi adequadamente avaliada.

OBJECTIVE: The aim of this study is to review eight pharmacologic antidepressant augmentation strategies in TRD. METHODS: Database search on Medline, LILACS and Cochrane Library, from 1990 to June 2006 using the words treatment, resistant, refractory, depression and the medical subject headings depression, drug resistance and augmentation. Double-blind controlled trials and reviews were included. We also consulted reference of the articles in order to obtain studies and original articles of historical value from before 1990. RESULTS: There were 17 double-blind trials with lithium, six with thyroid hormone, two with buspirone, six with pindolol one with carbamazepine, two with lamotrigine and four with olanzapine. Forty-one percent of the trials with lithium, 60 percent of those with thyroid hormone and tricyclics, 0 percent of the ones with thyroid hormone and selective serotonin reuptake inhibitors (SSRI), 50 percent of those with pindolol, 100 percent of those with carbamazepine and 40 percent of the ones with olanzapine were favorable. No trials with buspirone were favorable. The only trial with lamotrigine did not show efficacy using the main outcome measures. Otherwise, there was superiority over placebo on secondary measures. CONCLUSION: Only lithium and thyroid hormone showed efficacy as antidepressant augmentation strategies for TRD. Olanzapine was reasonably studied and did not prove its efficacy. There were just a few studies on buspirone and pindolol and they were not favorable to them. Carbamazepine was studied very little. Lamotrigine was not adequately evaluated.