Circadian markers as a predictor of response in the treatment of depression-A systematic review.

Despite many available treatment options for depression, response rates remain suboptimal. To improve outcome, circadian markers may be suitable as markers of treatment response. This systematic review provides an overview of circadian markers that have been studied as predictors of response in treatment of depression. A search was performed (EMBASE, PUBMED, PSYCHINFO) for research studies or articles, randomized controlled trials and case report/series with no time boundaries on March 2, 2024 (PROSPERO: CRD42021252333). Other criteria were; an antidepressant treatment as intervention, treatment response measured by depression symptom severity and/or occurrence of a clinical diagnosis of depression and assessment of a circadian marker at baseline. 44 articles, encompassing 8,772 participants were included in the analysis. Although additional research is needed with less variation in types of markers and treatments to provide definitive recommendations, circadian markers, especially diurnal mood variation and chronotype, show potential to implement as response markers in the clinic.

[Aftershocks; about the psychological consequences of gas extraction in Groningen]. / Naschokken; over de psychische gevolgen van de gaswinning in Groningen.

BACKGROUND: In recent decades, gas extraction in Groningen has led to a lot of material and immaterial damage, including much psychological suffering, which was ignored by policymakers for years. With the publication of the report of the Parliamentary Inquiry into Natural Gas Extraction in Groningen, this is recognized and suggestions are made to repair the damage caused in the broadest sense. AIM: Description of current and expected psychological consequences, and research and treatment to be conducted focused on this specific regional phenomenon. METHOD: Describing the Groningen situation based on various sources, and identifying current and expected mental consequences based on currently available data and scientific literature. RESULTS: Psychological consequences are largely known and identified, but not yet quantified. It is most important for the well-being of inhabitants that the government takes its care task seriously and supports victims in a practical sense. Subsequently, a targeted treatment offer must be developed. CONCLUSION: The knowledge available within psychiatry and psychology about the development and treatment of psychological complaints should play a role in researching and improving the well-being and the mental health of those affected by the gas extraction problem, now and in the future.

35 years of light treatment for mental disorders in the Netherlands.

BACKGROUND: Light therapy (LT) for Seasonal Affective Disorders (SAD) has been a well-known and effective treatment for 40 years. The psychiatric university clinic of Groningen, the Netherlands was an early adopter and started research and treatment of SAD in 1987. Research projects on mechanisms, the role of the circadian system, treatment optimization, and investigating new areas for the effects of light treatment have been carried out ever since, leading to a widespread interest across the country. OBJECTIVE: To provide an overview and description of the historical development of LT for mental disorders in the Netherlands. METHODS: A non-systematic, review of research on light treatment for mental problems in the Netherlands, published since 1987 was conducted. RESULTS: The fields of LT and chronotherapy are strongly based in the scientific interests of both chrono-biologists and therapists in the Netherlands. LT has shown effectiveness in treating mood disorders. Likewise, results for other mental disorders have shown some promise, but so far, the outcomes are not always unequivocal and have not always been based on robust data. Ongoing research is discussed. CONCLUSIONS: LT, and in addition exposure to the right light at the right time is an important issue in mental health. Over the past 3 decades research on light and LT in the Netherlands has become well established and is still growing.

[About quakes and biorhythms; sleeping problems in the Groningen earthquake area]. / Over bevingen en bioritme; slaapproblemen in het Groninger aardbevingsgebied.

BACKGROUND: Gas extraction-induced earthquakes have been taking place in the province of Groningen , the Netherlands, for many years. These lead to damage to homes and other buildings. This damage, and the way in which claims are handled, leads to physical and mental health problems, including sleeping problems. AIM: Drawing attention to the regional problems related to gas-extraction and, in particular, sleeping problems. METHOD: To describe of the background situation based on available sources and naming the mental consequences, especially sleep complaints. Also to calculate patterns in the course of the earthquakes related to the time of day and the season based on the KNMI (The Royal Netherlands Meteorological Institute) registrations since 12-8-2012. RESULTS: Most serious earthquakes in the last decade have occurred at night and when the sun has set. CONCLUSION: Because the most serious quakes take place during the period when it is dark during the day, this will influence sleeping behavior. Mental health care could play a role by stimulating research and treatment of these sleep complaints in order to prevent more serious complaints. Some possible suggestions are described.

[Interpersonal behavioral style as predictor of treatment outcome]. / Interpersoonlijke gedragsstijl als voorspeller van behandelresultaat.

BACKGROUND: Interpersonal behavioral style (IPBS) refers to the way in which someone behaves in social contact. IPBS affects the type and quality of different social interactions including the therapeutic relationship. The therapeutic relationship correlates with treatment outcome, IPBS possibly too. The direction of that relationship remains unclear. AIM: To examine the predictive value of IPBS on treatment outcome in group treatment. METHOD: 149 patients were divided in different types of IPBS: degree of affiliation (kindness vs. hostility), degree of dominance (dominant vs. submissive), quadrants (combination of affiliation and dominance) and vector length (strength of IPBS). Treatment outcome was measured in experienced psychopathology, social anxiety and frequency of social contact. Groups were compared by using one-way analysis of variance (ANOVA). Significant differences were analyzed using Tukey's post-hoc analysis. RESULTS: Vector length predicted all treatment outcome measures. The degree of dominance predicted only scores on social anxiety and frequency of social contact. The degree of affiliation did not predict any treatment results. CONCLUSION: Findings suggest that adult patients with stronger IPBS and a more submissive, sub-assertive IPBS experienced lower social anxiety scores and increased frequency of social contact after treatment. A stronger IPBS also predicts lower experienced psychopathology post-treatment. The degree of kindness/hostility does not affect treatment outcome.

Chronotype changes with age; seven-year follow-up from the Netherlands study of depression and anxiety cohort.

BACKGROUND: Chronotype reflects an individual's optimal daily timing of sleep, activity, and cognitive performance. Previous, cross-sectional, studies have suggested an age effect on chronotype with later chronotypes in adolescents and earlier chronotypes in children and elderly. Additionally, later chronotypes have been associated with more depressive symptoms. Few studies have been able to study longitudinal associations between chronotype and age, while adjusting for depressive symptoms. METHODS: Chronotype was assessed twice with the Munich Chronotype Questionnaire 7 years apart in the Netherlands Study of Depression and Anxiety (T1: N = 1842, mean age (SD): 42.63 years (12.66)) and T2: N = 1829, mean age (SD) 50.67 (13.11)). The longitudinal association between change in age and change in chronotype was tested using a generalized estimated equation analysis adjusted for covariates (including level of depressive symptoms). Using age-bins of 5 years (age at T2), change in chronotype between T1 and T2 was analyzed with Linear Mixed Models. RESULTS: We found a change towards an earlier chronotype with higher age (B (95% CI): -0.011 (-0.014-0.008), p < 0.001). For the age-bins, the difference in chronotype was significant for the 25-29 years age-bin. LIMITATIONS: The sample did not include individuals younger than 19 years or older than 68 years. CONCLUSIONS: In the whole sample chronotype changed towards becoming more morning-type over a period of 7 years, but this change was only significant for those aged 25-29 years. The study was performed in a large naturalistic cohort study with a wide age-range, including patients with a diagnosis of depressive and anxiety disorder and healthy controls.

[Housing, natural light and lighting, greenery and mental health]. / Huisvesting, lichtinval, groenvoorziening en geestelijke gezondheid.

BACKGROUND: Studies suggest that light and nature should be seriously considered when building new psychiatric clinics, because of their positive effects on psychiatric recovery.
AIM: To highlight positive and sustainable effects of light and greenery in mental health care.
METHOD: Literature study.
RESULTS: Daylight, artificial light and nature may have a positive influence on recovery and wellbeing of patients and employees in care institutions.
CONCLUSION: Taking light and nature into account in the design of a new psychiatric hospital is highly important. This can facilitate mental health of the users of the building.

[Treatment program for psychological work-related complaints: employees with or without a job in sick leave]. / Behandelprogramma voor psychische arbeidsgerelateerde klachten: werk­nemers in dienstverband versus UWV-vangnetters.

BACKGROUND: In the Netherlands, unemployed people in sick leave, can get sickness payment from the Employee Insurance Agency (UWV), so called 'vangnetters' (users of a safety net). They participated in a day-care program for people with psychological work-related complaints together with people in sick leave who were employed by an employer who were referred to a university psychiatric center (UCP).
AIM: Comparison of both groups on initial complaints and treatment outcome.
METHOD: A retrospective explorative study (during an 11-years period) comparing start and follow-up measurements by using questionnaires.
RESULTS: The UWV group (n = 111) differed from the UCP group (n = 254) at the start of the program: longer sickness leave, more severe initial complaints and a few other coping strategies. One year after finishing the program, 61% of the UWV group and 83% of the UCP group were in paid employment. People who were not in paid employment after a year already had more initial complaints compared to people who were back at work. The length of sickness leave was not a limiting factor for reintegration in work.
CONCLUSION: Differences in initial symptoms and coping strategies did not really lead to differences in perspective of reintegration in work. Cooperation with the UWV for employed as well as unemployed people in sick leave led to good treatment results.

Combined sleep deprivation and light therapy: Clinical treatment outcomes in patients with complex unipolar and bipolar depression.

BACKGROUND: The combination of sleep deprivation and light therapy, called combined chronotherapy, may yield positive short- and long-term results, even in patients with treatment resistant depression (TRD). The implementation of combined chronotherapy in daily clinical practice is rare. This study describes the implementation and the effectiveness in a clinical setting. METHODS: Twenty six depressed patients with unipolar or bipolar depression received combined chronotherapy consisting of three nights of sleep deprivation with alternating recovery nights, light therapy, and continuation of antidepressant medication. Inventory of Depressive Symptoms C (IDS-C) scores were determined before chronotherapy and at week 1, 2, and 4. Paired t-tests were used to compare the IDS-C scores over time. RESULTS: The mean pre-treatment IDS-C score was 39.3 ±â€¯9.6, the mean score in week 2 was 28.4 ±â€¯10.2, and 28.6 ±â€¯14.0 in week 4. A subsample of patients with psychiatric co-morbidities showed a reduction in depression severity from a mean score of 42.9 ±â€¯11.0 to a mean score of 34.9 ±â€¯13.0 after 4 weeks. The overall response rate was 34.6%, the remission rate 19.2%. LIMITATIONS: This open label case series has a relative small sample size and no control group CONCLUSION: In a clinical setting patients with major depressive disorder or bipolar disorder benefited significantly from combined chronotherapy. This chronotherapeutic intervention appears to have a rapid effect that lasts for at least several weeks, even in patients with psychiatric comorbidity or TRD. Indicating that chronotherapy can be a valuable treatment addition for depressed patients.

Can chronotype function as predictor of a persistent course of depressive and anxiety disorder?

BACKGROUND: The role of chronotype, the individual timing of sleep/activity, has been studied in relation to depressive and anxiety disorders. A cross-sectional association between a depressive episode and evening-type has been identified. However, until now the predicting capacity of chronotype concerning persistence of psychiatric disorders remains unclear. Our aim is to examine whether a later chronotype in patients with a depressive and/or anxiety disorder can serve as a predictor of a persistent course. METHODS: A subsample of patients with a depressive and/or anxiety disorder diagnosis and chronotype data of the longitudinal Netherlands Study of Depression and Anxiety (NESDA) was used. Diagnosis of depressive and anxiety disorders (1-month DSM-IV based diagnosis) were determined at baseline (n = 505). From this group persistence was determined at 2-year (FU2) (persistent course: n = 248, non-persistent course: n = 208) and 4-year follow-up (FU4) (persistent course: n = 151, non-persistent course: n = 264). Chronotype was assessed at baseline with the Munich Chronotype Questionnaire. RESULTS: A later chronotype did not predict a persistent course of depressive and/or anxiety disorder at FU2 (OR (95% CI) = 0.99 (0.83-1.19), P = 0.92) or at FU4 (OR (95% CI) = 0.94 (0.77-1.15), P = 0.57). LIMITATIONS: Persistence was defined as having a diagnosis of depressive and/or anxiety disorder at the two-year and four-year follow-up, patients may have remitted and relapsed between assessments. CONCLUSION: Chronotype, measured as actual sleep timing, of patients with a depressive or anxiety disorder did not predict a persistent course which suggests it might be unsuitable as predictive tool in clinical settings.

[Reasons for including the Inventory of Depressive Symptomatology (IDS) and its shortened version (QIDS) in routine outcome monitoring by the Foundation Benchmark Mental Health (SBG)]. / Inventory of Depressive Symptomatology en verkorte versie in routine outcome monitoring van Stichting Benchmark GGZ.

BACKGROUND: Increasingly, health insurance companies are asking for treatment results in mental health care to be expressed in actual numbers. They base their request on the data supplied by sbg (Stichting Benchmark ggz) and the procedures that sbg has followed. For the purpose of benchmarking, the sbg has accepted a limited number of questionnaires. These tools are not suitable for performing routine outcome monitoring (rom) in clinical practice. There is a urgent need for these questionnaires to be replaced by a widely-used depression questionnaire, namely the ids. AIM: To present arguments supporting the view that the ids is an excellent and useful instrument that the sbg should accept as a measuring tool. METHOD: We discuss the quality of the ids by reviewing the literature. RESULTS: The ids is a high quality instrument well suited for measuring the severity of depressions and also is sufficiently sensitive for measuring mood improvements.
CONCLUSION: The ids is an excellent tool for performing rom measurements and is available free of charge. The authors argue that the sbg should accept this questionnaire as a suitable instrument for benchmarking.

The duration of light treatment and therapy outcome in seasonal affective disorder.

BACKGROUND: Seasonal affective disorder (SAD) is characterized by recurrent episodes of major depression with a seasonal pattern, treated with light therapy (LT). Duration of light therapy differs. This study investigates retrospectively whether a single week of LT is as effective as two weeks, whether males and females respond differently, and whether there is an effect of expectations as assessed before treatment. METHODS: 83 women, and 25 men received either one-week (n=42) or two weeks (n=66) of LT were included in three studies. Before LT, patients׳ expectations on therapy response were assessed. RESULTS: Depression severity was similar in both groups before treatment (F(1,106)=0.19ns) and decreased significantly during treatment (main effect "time" F(2,105)=176.7, p<0.001). The speed of therapy response differs significantly in treatment duration, in favor of 1 week (F(2,105)=3.2, p=0.046). A significant positive correlation between expectations and therapy response was found in women (ρ=0.243, p=0.027) and not in men (ρ=-0.154,ns). When expectation was added as a covariate in the repeated-measures analysis it shows a positive effect of the level of expectation on the speed of therapy response (F(2,104)=4.1, p=0.018). LIMITATIONS: A limitation is the retrospective design. CONCLUSIONS: There is no difference between 1 and 2 weeks of LT in overall therapy outcome, but the speed of therapy response differed between 1 week LT and 2 weeks LT. Together with the significant correlation between expectations and therapy response in women, we hypothesize that expectations play a role in the speed of therapy response.

The effects of blue-enriched light treatment compared to standard light treatment in Seasonal Affective Disorder.

BACKGROUND: One of the most frequently investigated hypotheses of the pathophysiology underlying Seasonal Affective Disorder (SAD) is a disturbance of circadian rhythms. Since the circadian system as well as other non-visual effects is especially sensitive to blue light, a new light therapy device with blue enriched polychromatic light was tested for its efficacy to treat SAD. METHODS: Within one winter 52 patients were treated in one of three conditions: 30 min full spectrum light (9000 lx, 5000 K), 30 min blue-enriched light (9000 lx, 17,000 K), or 20 min blue-enriched light. The study lasted 22 days with 10 days of morning-light treatment on weekdays during the first 2 weeks. RESULTS: Depressive symptoms (SIGH SAD) diminished over the 3-week period in all conditions, with no significant differences between conditions. The percentage responders were high, differing from 75%, 59% and 71% for the standard-LT, 30 min blue-enriched-LT, and 20 min blue-enriched-LT, respectively. CONCLUSION: The lack of superiority of high intensity blue-enriched light over standard bright light treatment does not clearly support nor rule out the possibility of an important role for the circadian system or the blue sensitive non-visual image forming system in general, in the pathophysiology of SAD. The lack of a difference between conditions may also be the result of a saturated response to the high light intensities used. Recent data indeed suggest that low intensity blue-enriched light may be as effective as standard bright light treatment. The possibility of improving light therapy for SAD patients by applying light of shorter duration or at lower light intensities is highly relevant for optimizing treatment and will help to clarify the role of the circadian system and/or the non-image forming photoreceptors in SAD pathophysiology. CLINICAL TRIAL: https://register.clinicaltrials.gov: NCT01048294.

[Is it acceptable to use placebos in depression research?]. / Is het gebruik van placebo in onderzoek bij depressie aanvaardbaar?

The use of placebos in an investigation into the efficacy of a new type of treatment for winter depression was not approved by a medical ethics committee because some test subjects receiving placebos might thereby be deprived of an effective treatment. According to the authors, the committee's decision constituted an impediment to research and prevented a thorough investigation of a possible new type of treatment. In this essay it is argued that the use of placebos in depression research is ethically acceptable.

[A comparative study of two methods of personality assessment, the TCI and the NVM (Dutch shortened version of the MMPI)]. / Het meten van persoonlijkheidseigenschappen: een vergelijking van de TCI met de NVM.

BACKGROUND: Various types of reliable instruments are available for measuring personality dimensions. One of these instruments is the NVM, which is a Dutch shortened version of the Minnesota Multiphasic Personality Inventory, but its use is no longer permitted. AIM: To find out whether the Temperament and Character Inventory (TCI) can serve as an alternative to the NVM. METHOD: A study has compared the NVM questionnaire to the TCI, which is a personality questionnaire designed from a more psychiatric perspective. The two types of questionnaire were completed by 91 psychiatric (out)patients. Correlation analyses were performed. RESULTS: Statistically significant correlations were found between the various scales of the NVM and the TCI. Unique combinations of the TCI scales were found to predict the various NVM scales. CONCLUSION: It is worth considering the TCI as an alternative to the NVM.

Clinical efficacy of agomelatine in depression: the evidence.

Despite the advances of recent decades, there is still an urgent need for antidepressants with improved efficacy, safety and tolerability. Agomelatine is a new antidepressant with an innovative pharmacological profile. It is the first melatonergic antidepressant, and is a potent agonist of melatonin receptors (MT1 and MT2) with 5-HT2C antagonist properties. The efficacy of 25 mg/day agomelatine in treating major depressive disorder (MDD) has been demonstrated in a number of placebo-controlled studies. Evidence of improvement in depressive symptoms was observed in a dose-ranging study in which 25 mg/day agomelatine was significantly better than placebo, whatever the rating scale used (Hamilton Rating Scale for Depression, Clinical Global Impression, and Montgomery-Asberg Depression Rating Scale). These results have been confirmed in two similarly designed placebo-controlled studies. Agomelatine also produces a significant improvement in anxiety compared to placebo, according to Hamilton Rating Scale for Anxiety scores. The efficacy of agomelatine has been studied in subpopulations with more severe depression, demonstrating its efficacy in these difficult-to-treat patients. In view of the available data on agomelatine, this antidepressant can be regarded as an innovative treatment for MDD patients, offering a new approach in the management of depressed patients.