Consumo moderado de alcohol y prevención de la depresión. Una revisión crítica / Moderate alcohol consumption and depression prevention. A critical review

Introducción. Hay un claro consenso en torno a que los trastornos por uso de alcohol se asocian con una mayor incidencia y peor pronóstico de depresión, además de otros problemas médicos. Sin embargo, se está planteando que el consumo de alcohol moderado previene y mejora la evolución de algunas enfermedades crónicas, especialmente cardiovasculares. No obstante, otros investigadores sugieren que no hay un consumo seguro de alcohol debido a sus efectos globales sobre la salud (aumento del riesgo de cáncer, por ejemplo). En relación a la depresión, también hay evidencia dispar sobre el posible efecto antidepresivo del consumo moderado de alcohol. Esta revisión crítica intenta resumir dicha evidencia, así como analizar la posible influencia relativa de factores involucrados. Metodología. Se realizó una búsqueda a través de PubMedncon las siguientes palabras claves y operadores booleanos: (“light alcohol” OR “light drinking” OR “moderate alcohol” OR “moderate drinking” OR “low risk drinking” OR “low risk alcohol”) AND (depress*) NOT (dependence OR abuse). Resultados. La mayoría de los 24 estudios seleccionados fueron longitudinales. El consumo moderado de alcohol se asocia a menor sintomatología depresiva en la mayoría de los estudios. Sin embargo, estos estudios no descartan que esta asociación pueda explicarse alternativamente por importantes factores de confusión no causales (estado de salud, comportamiento prosocial, otros factores de estilo de vida relacionados, etc.). Conclusiones. No hay evidencia científica clara y consistente actual que respalde el consumo moderado de alcohol per se como factor protector frente a la depresión.(AU)

Background. There is a clear consensus that alcohol use disorders are associated with poorer outcomes concerning depression, and that drinking alcohol shouldn`t be recommended because of the risk of dependence. Until recently, literature focused almost exclusively on patients with alcohol use disorders and excludes patients with moderate alcohol use (MAU). It’s has been shown that MAU can prevent or improve the evolution of chronic diseases such as cardiovascular diseases, but several researchers have suggested that there is no safe level of alcohol drinking due to other effects on health. Nevertheless, there is some evidence regarding the antidepressant effect of moderate alcohol consumption. This critical review aims to sum up the direction and tendency of current research on the effect of MAU on depression and relate the causal or confounders factors that might explain the results. Methods. A research was carried out through PubMed with the following keywords and Boolean operators: (“light alcohol” OR “light drinking” OR “moderate alcohol” OR “moderate drinking” OR “low risk drinking” OR “low risk alcohol”) AND (depress*) NOT (dependence OR abuse). Results. Most of the 23 studies selected aim to investigate longitudinal effects. MAU prevents depressive symptoms in most studies, but it is still unclear to what extent this can be alternatively explained by neurochemical factors or other confounding factors (health status, sociability, other related lifestyle factors, etc.). Conclusion. There is currently no clear and consistent scientific evidence to support moderate alcohol consumption per se as a protective factor against depression.(AU)

Factor Structure of the Spanish Version of the Edinburgh Postnatal Depression Scale.

INTRODUCTION: The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in screening for postpartum depression. Although the Spanish version has been widely used, its factorial structure has not yet been studied . METHODS: A total of 1,204 women completed the EPDS 32 weeks after delivery. To avoid multiple testing, we split the sample into two halves, randomly drawing two subsamples of 602 participants each. We conducted exploratory factor analysis (EFA), followed by an oblimin rotation with the first sub-sample. Confirmatory factor analysis (CFA) was conducted using a Weighted Least Squares Means and Variance (WLSMV) estimation of the data. We explored different solutions between two and four factors. We compared the factors between two groups with depression and non-depression (evaluated with the Diagnostic Interview for Genetic Studies (DIGS) for the DSM-IV). RESULTS: The EFA indicated a three-factor model consisting of anxiety, depression and anhedonia. The results of the CFA confirmed the three-factor model (χ2=99.203, p<0.001; RMSEA=0.06, 90% CI=0.04/0.07, CFI=0.87 and TLI=0.82). Women with depression in the first 32 weeks obtained higher scores for anxiety, depression and anhedonia dimensions (p<0.001). CONCLUSIONS: This is the first study of confirmatory analysis with the Spanish version of EPDS in a large sample of women without psychiatric care during pregnancy. A three-factor model consisting of anxiety, depression and anhedonia was used. Women with depression had a higher score in the three dimensions of the EPDS.

Estructura factorial de la versión española de la Escala de Depresión Postnatal de Edimburgo / Factor Structure of the Spanish Version of the Edinburgh Postnatal Depression Scale

Introducción. La Escala de Depresión Postnatal de Edimburgo (EPDS) es considerada el gold standard para el cribado de depresión postparto. Aunque la versión española ha sido ampliamente utilizada, su estructura factorial no ha sido todavía analizada. Metodología. Un total de 1.204 mujeres completaron la EPDS a las 32 semanas del parto. Para evitar pruebas múltiples dividimos la muestra en dos mitades de 602 participantes. Se realizó un análisis factorial exploratorio (AFE) con rotación oblimin con la primera sub-muestra. Posteriormente, con la segunda de las muestras se realizó un análisis factorial confirmatorio (AFC) mediante la estimación Weighted Least Squares Means and Variance (WLSMV). Se exploraron diferentes soluciones entre dos y cuatro factores. Comparamos los factores en dos grupos de participantes con depresión y sin depresión (evaluados con la Entrevista Diagnóstica para Estudios Genéticos (DIGS) para el DSM-IV). Resultados. El AFE mostró un modelo de tres factores compuesto por ansiedad, depresión y anhedonia. Los resultados del AFC confirmaron el modelo de tres factores (χ2=99,203, p<0,001; RMSEA=0,06, 90% CI=0,04/0,07, CFI=0,87 y TLI=0,82). Mujeres con depresión a las 32 semanas tuvieron puntuaciones más elevadas en ansiedad, depresión y anhedonia (p<0,001). Conclusiones. Primer estudio de análisis confirmatorio de la versión española de la EPDS, en una amplia muestra de mujeres sin tratamiento psiquiátrico durante el embarazo. Un modelo de tres factores compuesto por ansiedad, depresión y anhedonia ha sido obtenido. Mujeres con depresión tuvieron una mayor puntuación en las tres dimensiones de la EPDS

Introduction. The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in screening for postpartum depression. Although the Spanish version has been widely used, its factorial structure has not yet been studied. Methods. A total of 1,204 women completed the EPDS 32 weeks after delivery. To avoid multiple testing, we split the sample into two halves, randomly drawing two subsamples of 602 participants each. We conducted exploratory factor analysis (EFA), followed by an oblimin rotation with the first sub-sample. Confirmatory factor analysis (CFA) was conducted using a Weighted Least Squares Means and Variance (WLSMV) estimation of the data. We explored different solutions between two and four factors. We compared the factors between two groups with depression and non-depression (evaluated with the Diagnostic Interview for Genetic Studies (DIGS) for the DSM-IV). Results. The EFA indicated a three-factor model consisting of anxiety, depression and anhedonia. The results of the CFA confirmed the three-factor model (χ2=99.203, p<0.001) RMSEA=0.06, 90% CI=0.04/0.07, CFI=0.87 and TLI=0.82). Women with depression in the first 32 weeks obtained higher scores for anxiety, depression and anhedonia dimensions (p<0.0101). Conclusions. This is the first study of confirmatory analysis with the Spanish version of EPDS in a large sample of women without psychiatric care during pregnancy. A three-factor model consisting of anxiety, depression and anhedonia was used. Women with depression had a higher score in the three dimensions of the EPDS

Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning.

OBJECTIVE: To investigate whether fibromyalgia induces axonal damage in the optic nerve that can be detected using optical coherence tomography (OCT), as the retinal nerve fiber layer (RNFL) is atrophied in patients with fibromyalgia compared with controls. METHODS: Fibromyalgia patients (n = 116) and age-matched healthy controls (n = 144) were included in this observational and prospective cohort study. All subjects underwent visual acuity measurement and structural analysis of the RNFL using two OCT devices (Cirrus and Spectralis). Fibromyalgia patients were evaluated according to Giesecke's fibromyalgia subgroups, the Fibromyalgia Impact Questionnaire (FIQ), and the European Quality of Life-5 Dimensions (EQ5D) scale. We compared the differences between fibromyalgia patients and controls, and analyzed the correlations between OCT measurements, disease duration, fibromyalgia subgroups, severity, and quality of life. The impact on quality of life in fibromyalgia subgroups and in patients with different disease severity was also analyzed. RESULTS: A significant decrease in the RNFL was detected in fibromyalgia patients compared with controls using the two OCT devices: Cirrus OCT ganglion cell layer analysis registered a significant decrease in the minimum thickness of the inner plexiform layer (74.99±16.63 vs 79.36±3.38 µm, respectively; p = 0.023), nasal inferior, temporal inferior and temporal superior sectors (p = 0.040; 0.011 and 0.046 respectively). The Glaucoma application of the Spectralis OCT revealed thinning in the nasal, temporal inferior and temporal superior sectors (p = 0.009, 0.006, and 0.002 respectively) of fibromyalgia patients and the Axonal application in all sectors, except the nasal superior and temporal sectors. The odds ratio (OR) to estimate the size effect of FM in RNFL thickness was 1.39. RNFL atrophy was detected in patients with FIQ scores <60 (patients in early disease stages) compared with controls in the temporal inferior sector (78.74±17.75 vs 81.65±3.61; p = 0.020) and the temporal superior sector (78.20±14.50 vs 80.74±3.88; p = 0.039) with Cirrus OCT; in the temporal inferior sector (145.85±24.32 vs 150.18±19.71; p = 0.012) and temporal superior sector (131.54±20.53 vs 138.13±16.67; p = 0.002) with the Glaucoma application of the Spectralis OCT; and in all sectors, except the average, nasal superior, and temporal sectors, and parameters with the Axonal application of the Spectralis OCT. Temporal inferior RNFL thickness was significantly reduced in patients with severe fibromyalgia (FIQ≥60) compared with patients with mild fibromyalgia (FIQ<60; 145.85±24.32 vs 138.99±18.09 µm, respectively; 145.43±13.21 vs 139.85±13.09 µm, p = 0.032 with the Glaucoma application and p = 0.021 with the Axonal application). The subgroup with biologic fibromyalgia exhibited significant thinning in the temporal inferior and superior sectors (115.17±20.82 µm and 117.05±24.19 µm, respectively) compared with the depressive (130.83±22.97 µm and 127.71±26.10 µm, respectively) and atypical (128.60±26.54 µm and 125.55±23.65 µm, respectively) subgroups (p = 0.005 and 0.001 respectively). CONCLUSIONS: Fibromyalgia causes subclinical axonal damage in the RNFL that can be detected using innocuous and non-invasive OCT, even in the early disease stages. The impact on the RNFL in the temporal sectors is greater in patients with biologic fibromyalgia, suggesting the presence of neurodegenerative processes in this subgroup of patients with fibromyalgia.

Salud mental y salud pública en España: vigilancia epidemiológica y prevención / Mental health and public health in Spain: epidemiological surveillance and prevention

Este documento destaca aspectos de la salud mental de interés en salud pública según una reunión de profesionales. La prevención primaria (más factible en daño cerebral traumático, depresión por estrés sociolaboral o económico, conductas adictivas en jóvenes y trastornos de incidencia creciente) habría de completarse con prevención secundaria y terciaria. La vigilancia según el esquema de las enfermedades crónicas (estudios de encuestas, publicaciones científicas, etc.) priorizaría la depresión, el suicidio, las adicciones y las patologías del espectro autista, así como los pacientes crónicos complejos. Serian abordajes específicos: 1) El estudio de diagnósticos al alta hospitalaria y de causas de muerte para trastornos mayores, suicidios, tentativas de suicidio, nuevos pacientes psicóticos y trastornos de personalidad y de conducta alimentaria en adolescentes y jóvenes. 2) La identificación de una red clínica de salud mental de base poblacional capaz de revelar determinados eventos centinela: ejemplo de Italia. 3) La realización de encuestas sobre determinadas problemáticas en población asistida (AU)

This document highlights aspects of mental health of interest in Public Health, as identified in a meeting of health professionals. Primary prevention (most feasible in traumatic brain injury, depression induced by socio-occupational or financial stress, addictive behaviours among adolescents and young adults, and disorders in which incidence is on the increase) would have to be completed with secondary and tertiary prevention. Surveillance patterned on that of chronic diseases (survey studies, scientific papers, etc.) would prioritise depression, suicide, addictions, autism spectrum disorders and complex chronic patients. This would entail specific approaches such as: 1) The study of hospital discharge diagnoses and causes of death for major disorders, suicides, attempted suicide, new psychotic patients, and personality and eating disorders among adolescents and youth. 2) The identification of a population-based, clinical mental-health networks capable of pinpointing certain sentinel events, as for example in Italy. 3) The undertaking of surveys of certain problem areas in the population requiring assistance (AU)

Coping strategies for postpartum depression: a multi-centric study of 1626 women.

The transition to motherhood is stressful as it requires several important changes in family dynamics, finances, and working life, along with physical and psychological adjustments. This study aimed at determining whether some forms of coping might predict postpartum depressive symptomatology. A total of 1626 pregnant women participated in a multi-centric longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the structured Diagnostic Interview for Genetic Studies (DIGS). The brief Coping Orientation for Problem Experiences (COPE) scale was used to measure coping strategies 2-3 days postpartum. Some coping strategies differentiate between women with and without postpartum depression. A logistic regression analysis was used to explore the relationships between the predictors of coping strategies and major depression (according to DSM-IV criteria). In this model, the predictor variables during the first 32 weeks were self-distraction (OR 1.18, 95 % CI 1.04-1.33), substance use (OR 0.58, 95 % CI 0.35-0.97), and self-blame (OR 1.18, 95 % CI 1.04-1.34). In healthy women with no psychiatric history, some passive coping strategies, both cognitive and behavioral, are predictors of depressive symptoms and postpartum depression and help differentiate between patients with and without depression.

The Mediterranean diet and micronutrient levels in depressive patients / Dieta mediterránea y niveles de micronutrientes en pacientes depresivos

Introduction: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. Objective: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. Methods: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. Results: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. Conclusion: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription (AU)

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y ácido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y ácido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea (AU)

Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey.

OBJECTIVES: Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. METHODS: A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. RESULTS: Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). CONCLUSION: Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed.

Prescripción de ejercicio físico en la depresión por parte de Médicos de Familia. Factores involucrados / Prescrição de exercício físico na depressao por parte de médicos de família. factores envolvidos / Exercise prescription for depression by general practitioners, factors involved

El problema del sedentarismo es acuciante en sociedades desarrolladas y sus consecuencias para la salud de la población constituyen uno de los principales problemas de salud pública actuales. La depresión es un motivo de consulta muy habitual en las consultas de atención primaria de países occidentales. Se ha planteado la prescripción de ejercicio físico como una estrategia antidepresiva útil en depresiones leves-moderadas, con frecuencia de forma complementaria a los tratamientos de primera elección. Sin embargo, los médicos de atención primaria no siempre lo prescriben y se desconoce de qué depende que lo hagan. Contribuir a aclarar esta cuestión es el objetivo del presente trabajo. Nuestra hipótesis era que el grado de prescripción depende de sus opiniones y experiencia sobre el tratamiento de la depresión.Se trata de un estudio descriptivo transversal en el que participaron 13 centros de salud. Utilizamos el cuestionario Depression Questionaire Attitude para valorar la actitud de los médicos hacia la depresión, y recogimos otras variables relacionadas con la importancia que otorgaban al ejercicio físico y a otros aspectos del estilo de vida en la salud física y mental. Los resultados confirman que la actitud de los médicos frente a la depresión influye en su disposición a recomendar ejercicio físico. Además, los médicos de atención primaria con menos años de práctica profesional valoran más el papel del ejercicio físico en la salud, tanto en la depresión como en otras patologías médicas. También se observa una correlación entre la importancia que se da al ejercicio físico en la salud y la que se da a otros factores ligados al estilo de vida, especialmente la dieta. Se concluye que aunque la utilidad de recomendar ejercicio físico en la depresión va acercándose al mismo nivel de importancia que en otros problemas de salud, su empleo por parte de los médicos de atención primaria es muy mejorable. Por ello, es importante insistir en la necesidad de ofrecer apoyo y programas de formación continuada a los médicos de atención primaria para ayudarles en este propósito (AU)

A sedentary lifestyle is an urgent problem in developed societies and its consequences are one of the main current problems in public health. Depression is a common reason to attend primary care in Western countries. In many cases of low and mild depression, exercise is recommended as a complement to the main therapy: Psychotherapy and/or pharmacotherapy. Nevertheless, general practitioners do not always recommend exercise to depressive patients and it is unknown why they do not. The main aim of our study was to clarify how the degree of prescribing exercise relies on a general practitioner’s opinion and experience in depression treatment. A cross-sectional design was undertaken in 13 public health centers. The Depression Attitude Questionnaire (DAQ) was used to evaluate general practitioners’ attitude towards depression; other variables related to the importance accorded to physical exercise; and other lifestyle aspects of physical and mental health. Our results show that general practitioners’ attitude towards depression influence their willingness to recommend exercise. Moreover, less experienced general practitioners (in years) tend to appreciate the importance of exercise in health, not only in depression. A positive relationship was found between importance of exercise and importance accorded to other factors linked to lifestyle, especially diet. Although recommendation of exercise in depression is similar to other medical conditions, its prescription may be improved. Hence, it is important to point out the need for education programs for general practitioners, in order to improve their capacity to deal with their task (AU)

O problema do sedentarismo é premente nas sociedades desenvolvidas e as suas consequências para a saúde da população constituem umdos principais problemas de saúde pública actuais. A depressão é um motivo muito habitual nas consultas de cuidados primários nos países ocidentais.Foi delineada a prescrição de exercício físico como uma estratégia antidepressiva útil em depressões leves-moderadas, de forma complementar aostratamentos de primeira escolha. Contudo, os médicos de cuidados primários nem sempre o prescrevem e desconhece-se o porquê de o fazerem. Contribuirpara clarificar esta questão é o objectivo do presente trabalho. A nossa hipótese era que o grau de prescrição depende das suas opiniões e experiênciasno tratamento da depressão. Trata-se de um estudo descritivo transversal no qual participaram 13 centros de saúde. Utilizámos o questionário DepressionQuestionaire Attitudepara avaliar a atitude dos médicos face à depressão e medimos outras variáveis relacionadas com a importância que atribuíam aoexercício físico e a outros aspectos do estilo de vida na saúde física e mental. Os resultados confirmam que a atitude dos médicos face à depressão influína sua disposição para recomendar exercício físico. Adicionalmente, os médicos de cuidados primários com menos anos de prática profissional valorizammais o papel do exercício físico na saúde, tanto na depressão como noutras patologias médicas. Também se observa uma correlação entre a importânciaque se dá ao exercício físico na saúde e à que se dá a outros factores ligados ao estilo de vida, especialmente à dieta. Conclui-se que apesar da utilidadede recomendar exercício físico na depressão se ir aproximando do nível de importância atribuído a outros problemas de saúde, a sua utilização por partedos médicos de cuidados primários pode ser substancialmente melhorada. Para tal, é importante insistir na necessidade de oferecer apoio e programasde formação continuada aos médicos de cuidados primários para ajudá-los neste propósito

Metabolic syndrome improvement in depression six months after prescribing simple hygienic-dietary recommendations.

BACKGROUND: Changes in diet and exercise have been separately demonstrated to improve Depression, although scientific evidence available is scarce. In a previously published controlled study, just recommending these and other lifestyle measures (sleep restriction and sunlight exposure) in combination once, patients experienced improvements in their depressive symptoms six months later. In this sample, one in three depressive patients had metabolic syndrome (MetS) at baseline. First line treatment of MetS condition is hygienic-dietetic, being Mediterranean diet and exercise especially important. Therefore we analyzed if lifestyle recommendations also improved their metabolic profile. FINDINGS: During the sixth month evaluation, a smaller number of patients from the group receiving hygienic-dietary recommendations met MetS criteria comparing with the control group. CONCLUSIONS: This study suggests that costless lifestyle recommendations, such as exercise and Mediterranean diet, have the capacity to promote both mental and physical health in a significant proportion of depressive patients. Further research is needed to confirm or discard these preliminary findings.

The Mediterranean diet and micronutrient levels in depressive patients.

INTRODUCTION: An inverse association between depression and some serum micronutrient levels (selenium, zinc, iron, magnesium, vitamin B and folic acid) has been reported. In addition, other studies reported that this micronutrient supplementation may improve depressed mood. The Mediterranean diet contains a sufficient amount of the micronutrients mentioned, although no study has reported an association between diet prescription and increased levels of them in depressive patients. OBJECTIVE: To examine the impact of dietary patterns recommendations on micronutrient levels in depressive patients. METHODS: 77 outpatients were randomly assigned either to the active (hygienic-dietary recommendations on diet, exercise, sleep, and sun exposure) or control group. Outcome measures were assessed before and after the six month intervention period. RESULTS: Serum selenium and zinc levels were slightly low at basal point and serum selenium was inversely correlated with severity of depression (r=-0.233; p=0.041). A better outcome of depressive symptoms was found in the active group. Nevertheless, no significant differences in micronutrient levels were observed after the Mediterranean diet pattern prescription, probably due to an insufficient adherence. CONCLUSION: Selenium, zinc, iron, magnesium, vitamin B12 and folic acid serum levels didn`t increase in depressed patients after six months of the Mediterranean diet pattern prescription.

Introducción: Se ha comunicado una correlación inversa entre depresión y el nivel sérico de algunos micronutrientes (selenio, zinc, hierro, magnesio, vitamina B y acido fólico). Además, otros estudios han señalado que la suplementar de estos micronutrientes puede mejorar la depresión. La dieta mediterránea proporciona una suficiente cantidad de los micronutrientes mencionados, aunque ningún estudio ha probado si la prescripción de dicha dieta puede incrementar los niveles de micronutrientes en pacientes depresivos. Objetivo: Examinar el impacto de recomendar un patrón dietético mediterráneo en los niveles de micronutrientes de pacientes deprimidos. Material y Métodos: 77 pacientes ambulatorios se aleatorizaron entre un grupo de intervención (recomendaciones higiénico-dietéticas sobre dieta, ejercicio, sueño y exposición solar) y un grupo control. La evolución fue evaluada antes y después de los seis meses del periodo de intervención. Resultados: Los niveles de selenio y de zinc fueron ligeramente bajos en la determinación basal y el nivel de selenio correlacionaba inversamente con la severidad de la depresión (r=-0.233; p=0.041). El grupo activo evolucionó mejor de la clínica depresiva. Sin embargo, no se observaron diferencias significativas en los niveles de micronutrientes después de la prescripción del patrón de dieta mediterránea probablemente a causa de una insuficiente adherencia. Conclusión: Los niveles séricos de selenio, zinc, hierro, magnesio vitamina B12 y acido fólico no aumentaron en pacientes depresivos seis meses después de prescribir un patrón de dieta mediterránea.

Los hábitos de vida saludables tienen un efecto antidepresivo / Healthy life habits have an antidepressant effect

La depresión es un problema de salud importante y en crecimiento. Las dos piedras angulares de su tratamiento son la psicofarmacología y la psicoterapia, pero sus resultados están lejos de ser satisfactorios en algunos casos. Este artículo ofrece una visión general de cuatro estrategias complementarias para el tratamiento de la depresión. Se ha sugerido que los factores relacionados con el estilo de vida pueden contribuir a la aparición y el mantenimiento de la depresión. Además, hay una creciente cantidad de información acerca de que las recomendaciones sobre aspectos del estilo de vida como la dieta, el ejercicio físico, la exposición a la luz solar, así como técnicas conductuales para regular el ciclo vigilia sueño pueden ser útiles en el tratamiento. Sin embargo, hay poca investigación acerca de la utilidad de combinar estas sencillas medidas higiénico-dietarias y asociarlas con el tratamiento antidepresivo...

Persistence of chronic major depression: a national prospective study.

BACKGROUND: Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. METHODS: Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. RESULTS: Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. LIMITATIONS: Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. CONCLUSIONS: CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.

Residual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis.

BACKGROUND: The degrees to which residual symptoms in major depressive disorder (MDD) adversely affect patient functioning is not known. This post-hoc analysis explored the association between different residual symptoms and patient functioning. METHODS: Patients with MDD who responded (≥50% on the 17-item Hamilton Rating Scale for Depression; HAMD-17) after 3 months of treatment (624/930) were included. Residual core mood-symptoms (HAMD-17 core symptom subscale ≥1), residual insomnia-symptoms (HAMD-17 sleep subscale ≥1), residual anxiety-symptoms (HAMD-17-anxiety subscale ≥1), residual somatic-symptoms (HAMD-17 Item 13 ≥1), pain (Visual Analogue Scale ≥30), and functioning were assessed after 3 months treatment. A stepwise logistic regression model with normal functioning (Social and Occupational Functioning Assessment Scale ≥80) as the dependent variable was used. RESULTS: After 3 months, 59.5% of patients (371/624) achieved normal functioning and 66.0% (412/624) were in remission. Residual symptom prevalence was: core mood symptoms 72%; insomnia 63%; anxiety 78%; and somatic symptoms 41%. Pain reported in 18%. Factors associated with normal functioning were absence of core mood symptoms (odds ratio [OR] 8.7; 95% confidence interval [CI], 4.6-16.7), absence of insomnia symptoms (OR 1.8; 95% CI, 1.2-2.7), episode length (4-24 weeks vs. ≥24 weeks [OR 2.0; 95% CI, 1.1-3.6]) and better baseline functioning (OR 1.0; 95% CI, 1.0-1.1). A significant interaction between residual anxiety symptoms and pain was found (p = 0.0080). CONCLUSIONS: Different residual symptoms are associated to different degrees with patient functioning. To achieve normal functioning, specific residual symptoms domains might be targeted for treatment.

Adherencia a las recomendaciones sobre estilo de vida en pacientes con depresión / Adherence to lifestyle recommendations by patients with depression

Introducción. La práctica de ejercicio físico y la exposición a la luz solar cada vez tiene mayor respaldo experimental sobre su eficacia antidepresiva coadyuvante en pacientes con depresión leve o moderada. Sin embargo, no hay información objetiva disponible sobre el grado de adherencia que los pacientes depresivos son capaces de desarrollar frente a estas recomendaciones en condiciones de práctica habitual, lo que limita la tendencia del clínico a prescribirlas. Métodos. Se estudia una muestra de 15 pacientes con un episodio depresivo de más de un mes de evolución con tratamiento antidepresivo a los que se les colocó un actígrafo en forma de reloj de pulsera capaz de medir la actividad física y la exposición a la luz durante las 24 horas del día. Una semana después de la evaluación basal estos pacientes fueron aleatorizados en 2 grupos. En el primero de ellos se les pedía en una breve nota por escrito de forma explícita y concreta que aumentaran la actividad física y la exposición a la luz solar, mientras que en el segundo grupo no. Resultados. En la semana posterior a la entrega de las recomendaciones, solo el primer grupo aumentó su actividad física y su exposición a la luz (14,3 y 25,8% respectivamente). Conclusión. Los pacientes con depresión muestran un buen nivel de adherencia a recomendaciones sobre su estilo de vida a corto plazo(AU)

Introduction. There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. Methods. We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24h a day. After one week of baseline assessment, patients were randomized into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. Results. One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). Conclusions. Depressive patients are able to follow prescribed lifestyle recommendations in the short-term(AU)

Adherence to lifestyle recommendations by patients with depression.

INTRODUCTION: There is an increasing amount of evidence showing that physical activity and sun exposure are effective coadjuvant treatments for patients with mild to moderate depression. However, there is a lack of information regarding patient's adherence to these recommendations in daily clinical practice. METHODS: We conducted a study including 15 depressive patients who had been under antidepressant treatment for at least one month. They wore a wrist-watch-like actimetry sensor to measure physical activity and sun exposure 24 hours a day. After one week of baseline assessment, patients were randomised into one of the two arms of the study. Patients in the experimental group received a brief note in which they were explicitly asked to increase both their physical activity level and time of sun exposure, while control group patients did not receive these explicit recommendations. RESULTS: One week after recommendations were delivered, only patients in the experimental group had increased time of sun exposure and physical activity (25.8% and 14.3%, respectively). CONCLUSIONS: Depressive patients are able to follow prescribed lifestyle recommendations in the short-term.

Four hygienic-dietary recommendations as add-on treatment in depression: a randomized-controlled trial.

BACKGROUND: Modifying diet, exercise, sunlight exposure and sleep patterns may be useful in the treatment of depression. METHOD: Eighty nonseasonal depressive outpatients on anti-depressant treatment were randomly assigned either to the active or control group. Four hygienic-dietary recommendations were prescribed together. Outcome measures were blinded assessed before and after the six month intervention period. RESULTS: A better evolution of depressive symptoms, a higher rate of responder and remitters and a lesser psychopharmacological prescription was found in the active group. LIMITATIONS: Small sample size. Lacked homogeneity concerning affective disorders (major depression, dysthimia, bipolar depression). CONCLUSIONS: This study suggests lifestyle recommendations can be used as an effective antidepressant complementary strategy in daily practice.

Nuevas técnicas de neuroestimulación en las adicciones / New neurostimulation techniques in adicctions

Las adicciones se asocian a modificaciones en los patrones de activación cerebral. En los últimos años se han desarrollado nuevas técnicas de neuroestimulación capaces de modificar la actividad de los circuitos cerebrales, y que se están explorando en el tratamiento de las adicciones. Las más importantes son la Estimulación Magnética Transcraneal (EMT), la Estimulación Transcraneal de Corriente Directa (ETCD), la Estimulación del Nervio Vago (ENV) y la Estimulación Cerebral Profunda (ECP). Los hallazgos publicados hasta ahora son aún insuficientes para proponerlas como alternativas terapéuticas en los trastornos por uso de sustancias (AU)

Addiction is associated with changes in brain activation patterns. In recent years new techniques of neurostimulation that can alter the activity of brain circuits have been developed, and are being explored in the treatment of addictions. The most important of these techniques are Transcranial Magnetic Stimulation (TMS), Transcranial Direct Electrical Stimulation (tDCS), Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS). The findings reported are clearly still insufficient for them to be considered as therapeutic alternatives in substance use disorders (AU)

Comparative efficacy of two primary care interventions to assist withdrawal from long term benzodiazepine use: a protocol for a clustered, randomized clinical trial.

BACKGROUND: Although benzodiazepines are effective, long-term use is not recommended because of potential adverse effects; the risks of tolerance and dependence; and an increased risk of hip fractures, motor vehicle accidents, and memory impairment. The estimated prevalence of long-term benzodiazepine use in the general population is about 2,2 to 2,6%, is higher in women and increases steadily with age. Interventions performed by General Practitioners may help patients to discontinue long-term benzodiazepine use. We have designed a trial to evaluate the effectiveness and safety of two brief general practitioner-provided interventions, based on gradual dose reduction, and will compare the effectiveness of these interventions with that of routine clinical practice. METHODS/DESIGN: In a three-arm cluster randomized controlled trial, general practitioners will be randomly allocated to: a) a group in which the first patient visit will feature a structured interview, followed by visits every 2-3 weeks to the end of dose reduction; b) a group in which the first patient visit will feature a structured interview plus delivery of written instructions to self-reduce benzodiazepine dose, or c) routine care. Using a computerized pharmaceutical prescription database, 495 patients, aged 18-80 years, taking benzodiazepine for at least 6 months, will be recruited in primary care health districts of three regions of Spain (the Balearic Islands, Catalonia, and Valencia). The primary outcome will be benzodiazepine use at 12 months. The secondary outcomes will include measurements of anxiety and depression symptoms, benzodiazepine dependence, quality of sleep, and alcohol consumption. DISCUSSION: Although some interventions have been shown to be effective in reducing benzodiazepine consumption by long-term users, the clinical relevance of such interventions is limited by their complexity. This randomized trial will compare the effectiveness and safety of two complex stepped care interventions with that of routine care in a study with sufficient statistical power to detect clinically relevant differences. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN13024375.