Sex-specifics of ECT outcome.

OBJECTIVE: Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS: Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS: Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION: The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.

Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study.

Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.

Improving survival and growth of planted Austrocedrus chilensis seedlings in disturbed patagonian forests of Argentina by managing understory vegetation.

This study was aimed at determining, under field conditions, early interactions between planted cypress seedlings and their associated shrubs in a mesic area of Andean Patagonia and, in a nursery, the effects of increasing light availability on cypress performance when soil water was not a limiting factor. The field experiment was performed in a former cypress-coihue mixed forest (42°02'S, 71°33'W), which was replaced in the 1970s by a plantation of radiata pine. In 2005, 800 cypress seedlings were planted under maqui shrubs in a clear-cut area of the pine stand. In 2007, two treatments were set: no-competition treatment ([NCT] i.e., the surrounding aboveground biomass was removed) and competition treatment ([CT] i.e., without disturbance). The nursery experiment (42°55'S, 71°21'W) consisted of two groups: "shade" (grown under shade cloth) and "sun" (grown at full sun) cypress seedlings. After one growing season, seedling survival and stem growth (in height and diameter) were determined at both sites. Furthermore, the growth rate of leaves, stems, and roots was determined in the nursery. In the field experiment, height growth and survival in NCT were significantly greater than in CT, and a competition process occurred between cypress and surrounding shrubs. In the nursery, sun plants grew more in diameter and increased root weight more than shade plants. Results also showed that in mesic areas of Patagonia, decreasing competition and increasing light levels produced stouter seedlings better adapted to support harsh environmental conditions. Therefore, the removal of protecting shrubs could be a good management practice to improve seedling establishment.

A haplotype of glycogen synthase kinase 3ß is associated with early onset of unipolar major depression.

Recent findings suggest that glycogen synthase kinase 3ß (GSK3ß) may play a role in the pathophysiology and treatment of mood disorders. Various genetic studies have shown the association of GSK3ß polymorphisms with different mood disorder phenotypes. We hypothesized that genetic variants in the GSK3ß gene could partially underlie the susceptibility to mood disorders. We performed a genetic case-control study of 440 psychiatrically screened control subjects and 445 mood disorder patients [256 unipolar major depressive disorder (MDD) and 189 bipolar disorder (BD)]. We genotyped a set of 11 single nucleotide polymorphisms (SNPs) and determined the relative frequency of a known copy number variant (CNV) overlapping the GSK3ß by quantitative real-time polymerase chain reaction (PCR). We found no evidence of association with MDD or BD diagnosis, and we further investigated the age at onset (AAO) of the disorder and severity of depressive index episode. We found that rs334555, located in intron 1 of GSK3ß, was nominally associated with an earlier AAO of the disease in MDD (P = 0.001). We also identified a haplotype containing three SNPs (rs334555, rs119258668 and rs11927974) associated with AAO of the disorder (permutated P = 0.0025). We detected variability for the CNV, but we could not detect differences between patients and controls for any of the explored phenotypes. This study presents further evidence of the contribution of GSK3ß to mood disorders, implicating a specific SNP and a haplotype with an earlier onset of the disorder in a group of well-characterized patients with unipolar MDD. Further replication studies in patients with the same phenotypic characteristics should confirm the results reported here.

[Circadian rhythms and depression]. / Ritmos circadianos y depresión.

Some core symptoms of major depression show a circadian rhythm in their clinical manifestations or are intimately linked to the circadian system functioning, such as sleep-wake cycle. Moreover, abnormalities in circadian rhythms of core body temperature and some endocrine-metabolic parameters have been detected in depressive patients compared to healthy controls. The circadian rhythm disturbances described in depressive states as well as the efficacy and fast onset of action of chronobiological based treatments point out the circadian system as an therapeutic target in the treatment of depression. The aim of this work is to review the biological and clinical data that link major depression to circadian rhythm abnormalities, the mechanisms that may underlie the abnormalities of circadian rhythm physiology seen in depressive states and the different therapeutic approaches to depression that involve the circadian system in their mechanisms of action.

Ritmos circadianos y depresión / Circadian rhythms and depression

Determinados síntomas nucleares de la depresión mayor muestran ritmicidad circadiana en su expresión clínica o están íntimamente vinculados al funcionamiento del sistema circadiano, como las alteraciones del ciclo sueño-vigilia. Asimismo, en los sujetos depresivos se han detectado alteraciones en los ritmos circadianos de temperatura corporal y varios parámetros endocrino metabólicos en comparación con individuos sanos. Las anomalías en los ritmos circadianos descritas en los estados depresivos, así como la eficacia y rapidez de acción de tratamientos basados en cronobiología, señalan al sistema circadiano como una importante diana terapéutica en el tratamiento de la depresión. El objetivo del presente trabajo es revisar los datos clinicobiológicos que vinculan a la depresión mayor con alteraciones de los ritmos circadianos, los mecanismos que pueden conducir a las anomalías de la ritmicidad fisiológica descritas en los estados depresivos y los diferentes abordajes terapéuticos de la depresión que implican al sistema circadiano en su mecanismo de acción (AU)

Some core symptoms of major depression show a circadian rhythm in their clinical manifestations or are intimately linked to the circadian system functioning, such as sleep-wake cycle. Moreover, abnormalities in circadian rhythms of core body temperature and some endocrine metabolic parameters have been detected in depressive patients compared to healthy controls. The circadian rhythm disturbances described in depressive states as well as the efficacy and fast onset of action of chronobiological based treatments point out the circadian system as an important therapeutic target in the treatment of depression. The aim of this work is to review the biological and clinical data that link major depression to circadian rhythm abnormalities, the mechanisms that may underlie the abnormalities of circadian rhythm physiology seen in depressive states and the different therapeutic approaches to depression that involve the circadian system in their mechanisms of action (AU)

Introducción. Grupo de trabajo para el tratamiento a largo plazo de la depresión / Introduction. Task force on long-term treatment of depression

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Conceptos prácticos para la clasificación y el manejo de la depresión largo plazo / Long-term depression: practical concepts of classification and management

En el manejo de la depresión a largo plazo es necesario tener en cuenta algunos conceptos clave: características evolutivas de los episodios depresivos, instauración del primer episodio clínico, número de episodios, duración, intervalos y ciclos, patrones de curso, etc. El tratamiento a largo plazo es un concepto amplio que incluiría el tratamiento o la estrategia terapéutica realizada tras finalizar el tratamiento agudo. Se ha dividido en tratamiento de continuación o consolidación y tratamiento de mantenimiento o profiláctico. Desde un punto de vista conceptual otros términos y definiciones son relevantes: la remisión parcial supone que el paciente presenta clínica depresiva sin cumplir ya criterios de episodio o síndrome completo. La respuesta puede considerarse en el momento que se inicia la remisión parcial. La remisión parcial puede ser espontánea, aunque se tiende a asumir que es secundaria a la efectividad del tratamiento ensayado. La ausencia de evolución de la remisión parcial a la remisión total plantea la necesidad de ensayar nuevas estrategias terapéuticas. Los síntomas residuales indican el primer escalón de otros más graves como la recidiva episódica y la cronicidad. En la literatura se relaciona la «sintomatología residual» con una mayor frecuencia de recidivas episódicas. La remisión completa se refiere a la ausencia de síntomas significativos de depresión durante un tiempo determinado (al menos 2 meses). La recuperación se sitúa en un continuum entre estar libre de síntomas depresivos hasta sufrir síntomas leves o moderados. Se define recaída como un episodio clínico separado del previo por menos de 6 meses y recurrencia por más de 6 meses (AU)

In the long-term management of depression is necessary to take into account some key concepts: evolutive characteristics of depressive episodes, first clinical episode onset, number of episodes, duration, intervals and cycles, course of illness, etc. Long-term treatment is a broad term that would include the treatment or therapeutic strategy used once the acute treatment is over. It has been divided into continuation or consolidation treatment and maintenance or prophylactic treatment. Conceptually, other terms and definitions are relevant: partial remission implies a depressive symptomatology without criteria for a complete episode or syndrome. Response may be considered once partial remission has begun. Partial remission may be spontaneous, though there is a trend to assume that is secondary to the study drug’s effectiveness. The absence of evolution of partial to total remission creates the need to test new therapeutic strategies. Residual symptoms are the first step to more severe ones such as episodic relapse and chronicity. «Residual symptomatology» is associated in literature with a higher rate of relapses. Full remission implies lack of significant depressive symptoms for a determined period of time (at least 2 months). Recovery is a continuum between absence of depressive symptoms and mild or moderate symptoms. Relapse is defined by a clinical episode at least 6 months after the previous one and recurrence over 6 months (AU)

Factores de riesgo y predictores de evolución en la depresión a largo plazo / Risk factors and outcome predictors in the long-term depression

Los estudios evolutivos señalan diversas variables basales sociodemográficas como predictores en mayor o menor medida de la evolución crónica de los trastornos depresivos: sexo, edad de comienzo y presencia de antecedentes familiares, aunque pueden citarse otros muchos más controvertidos. Los estudios de neuroimagen han mostrado por lo general asociaciones positivas entre la presencia de alteraciones estructurales y un pronóstico adverso de la depresión, tanto una evolución hacia la cronicidad como hacia la aparición de un síndrome demencial. Se revisan otros grandes tipos de factores. Un grupo relacionado con el curso de la enfermedad: número de episodios y persistencia de los síntomas. Otro grupo de factores reúne los que tienen que ver con las características clínicas propiamente dichas: presencia o ausencia de determinados síntomas o conjuntos de síntomas. Finalmente, un tercer factor clínico de gran importancia es la comorbilidad, tanto somática como psiquiátrica. Los problemas de reconocimiento y diagnóstico de la depresión y el empleo de herramientas terapéuticas inadecuadas o insuficientes son todavía demasiado frecuentes. Por otra parte, la mala adherencia al tratamiento sigue constituyendo un problema crucial en el tratamiento a largo plazo de la depresión (AU)

Outcome studies indicate that some baseline sociodemographic variables are predictors of the chronic evolution of depressive disorders: gender, onset and existence of family psychiatric history, among others, much more controversial. Neuroimage studies have generally shown positive associations between the existence of structural changes and an adverse prognosis of depression, towards an evolution to chronicity or onset of a demential syndrome. Other major types of factors have been revised as well. One group related with the course of the disease: number of episodes and persistence of symptoms. Another group of factors gathers those related with clinical characteristics: presence or absence of determined symptoms or groups of symptoms. Finally, a third clinical factor of great relevance is comorbidity, both somatic and psychiatric. Problems in the recognition and diagnosis of depression and the use of unsuitable or inadequate therapeutic tools are still too frequent. Besides, treatment noncompliance is still a crucial problem for the long-term treatment of depression (AU)

Tratamientos psicofarmacológicos de la depresión a largo plazo / Psychopharmacological treatments of the long-term depression

Revisamos los estudios farmacológicos a largo plazo (2 años) en el tratamiento de la depresión. Se realizó una revisión de la literatura publicada en las principales bases de datos en psiquiatría. Existen 11 estudios de tratamiento de la depresión a largo plazo con un mínimo de 2 años de evaluación en la fase de mantenimiento. Sólo 5 de estos estudios tiene resultados positivos y abarcan poblaciones clínicas con edad mayor de 18 años en las muestras incluidas: imipramina (2), amitriptlina, fenelzina y venlafaxina retard. Los estudios con dotiepina, nortriptilina (2), sertralina y paroxetina sólo incluyen pacientes con edades superiores a60 años. Un total de 2.705 pacientes participa en la primera fase de los estudios y 967 son finalmente aleatorizados en la fase de mantenimiento. Las muestras más extensas en la segunda fase son las de los estudios con imipramina con 150 y 128 pacientes y la de venlafaxina retard que incluye a131 pacientes en la última fase. Nuevos estudios con series largas e inclusión clara de fases agudas, criterios de remisión sostenida y fases de continuación y mantenimiento alargo plazo permitirán contrastar estos datos acerca de la prevención farmacológica de recurrencias en el tratamiento de los trastornos depresivos (AU)

We review the pharmacological studies in the long term (2 years) treatment of depression. An online literature review of the main psychiatric searches was conducted. There are 11 studies regarding long-term depression treatment establishing a minimum 2 years follow-up period. Only five of these studies obtain positive results with clinical populations over 18 years old in the included samples: imipramine (2), amytriptiline, phenelzine and venlafaxine extended release. Studies regarding dotiepine, nortriptiline(2), sertraline and paroxetine only include patients over 60 years old. One study with sertraline shows negative results for the prevention of recurrences in elderly patients. A total of 2,705 patients participated in the first phase of the study. The largest samples for the second period belong to studies with imipramine involving 150 y 128 patients, and the study regarding venlafaxine extended release which includes 131 patients in the last phase of the maintenance period. Emerging studies using large samples and clear inclusion of acute phases, continued remission criteria, and continuation and long-term maintenance phases will allow to contrast these data about pharmacological prevention of recurrences in the treatment of depressive disorders (AU)

Psicoterapia en la depresión a largo plazo / Psychoterapy in the long-term depression

Presentamos los datos procedentes de una revisión de la literatura publicada en PubMed. Existen diversos estudios que muestran la eficacia o la efectividad de determinadas intervenciones psicoterapéuticas para el tratamiento de la depresión a largo plazo: la psicoterapia de modificación de conducta, la terapia cognitivo-conductual y la psicoterapia interpersonal. Sin embargo, los ensayos clínicos en este terreno adolecen por lo general de serias limitaciones: los criterios diagnósticos utilizados, falta de especificación de los criterios de inclusión de los sujetos sometidos a estudio, gravedad del trastorno, ausencia de seguimiento postratamiento y en múltiples ocasiones ausencia de grupos control para comparar los resultados obtenidos. Se discuten los estudios existentes hasta el momento y de manera especial las controversias en el posible uso combinado de tratamientos psicoterapéuticos y psicofarmacológicos en la prevención de recurrencias depresivas (AU)

studies show the efficacy and effectiveness of some particular psychotherapeutic interventions for the long term depression treatment: behavioural therapy, cognitive-behaviour therapy and interpersonal therapy. However, clinical trials in this field generally present important limitations: the selected diagnosis criteria, lack of specification regarding inclusion criteria for involved subjects severity of the disorder, absence of post-treatment follow up and in a lot of cases, lack of control group to compare the obtained results. We discuss the existing studies so far and, particularly, the controversies in the combined use of psychotherapeutic and psychopharmacological treatments for the prevention of depression recurrences (AU)

Depresiones resistentes / Treatment-resistant depression

Los criterios básicos de depresión resistente se definen como un episodio de depresión unipolar primaria que no responde a 300 mg de imipramina o a un antidepresivo equivalente, con un tiempo mínimo de espera para la respuesta de 6 semanas, siempre que se asegure el cumplimiento terapéutico. Existen diversas opciones para el tratamiento de estos pacientes, con diferentes evidencias científicas. Se discuten las estrategias de optimización, potenciación, sustitución y combinación, así como el uso de la terapia electroconvulsiva y se plantean recomendaciones específicas mediante algoritmos de tratamiento. Los tiempos de espera de respuesta terapéutica en las potenciaciones serán al menos de 2 semanas y no superiores a las 4 semanas. En la adición de litio la espera debe ser de4 semanas. El tratamiento indefinido después de un tercer episodio está basado en el riesgo de recurrencia que supera el 90% y el riesgo de autólisis, que es similar en cada episodio. Después de un primer episodio se recomienda, por tradición y duración teórica del mismo, mantener la medicación 6 meses. Sin embargo, aconsejamos un tiempo no inferior a 9 meses, ya que la prolongación del tratamiento de continuación asegura la cobertura completa del episodio (AU)

Basic criteria for treatment-resistant depression are defined as one primary unipolar depression episode that does not respond to 300 mg of imipramine or an equivalent antidepressant, with a minimum time to response of 6 weeks, assuring good treatment compliance. There are various options for the treatment of these patients, with different scientific evidence. Strategies for the optimization, augmentation, substitution and combination, as well as the use of electroconvulsive therapy are discussed, and specific algorithmic-based recommendations are proposed. Time to therapeutic response in augmentations will be of at least 2 weeks and not greater than 4 weeks. When adding lithium the latent period should be of f4 weeks. Lifelong treatment after a third episode is based on the risk of recurrence over 90% and the risk of autolysis, which is similar in each episode. The recommendation after the first episode, due to the common practice and its theorical duration, is to maintain the treatment for 6 months. However, we recommend a period of time of not less than9 months, as the extension of the continuation treatment assures the complete management of the episode (AU)

Complicaciones de la depresión a largo plazo / Consequences of the long-term depression

La comorbilidad entre enfermedades medico quirúrgicas y la depresión está bien documentada. Entre los trastornos físicos que se han encontrado asociados al trastorno depresivo están la artritis, el cáncer, las enfermedades pulmonares, los trastornos neurológicos y las enfermedades cardíacas. Otros trastornos psiquiátricos son con frecuencia comórbidos con los trastornos depresivos: el abuso de alcohol o drogas, los trastornos de ansiedad y el trastorno obsesivo-compulsivo, así como los trastornos de la conducta alimentaria en mujeres. La depresión multiplica por tres el riesgo de mortalidad cardíaca. Si la depresión no es tratada, incrementa el riesgo de suicidio o de otros actos violentos. El tratamiento reducirá a la mitad el riesgo de suicidio, especialmente para los hombres de menos de 30 años. El abuso de alcohol o drogas, el desempleo, el aislamiento social y la impulsividad aumentan el riesgo de suicidio. Finalmente revisamos los únicos fármacos que se han mostrado efectivos en la reducción de las conductas suicidas: el litio en el riesgo de suicidio del trastorno bipolar y la clozapina en el riesgo de suicidio de los pacientes con esquizofrenia o trastorno esquizoafectivo (AU)

Comorbidity between medical-surgical diseases and depression is well documented. Among the somatic disorders associated to the depressive disorder are arthritis, cancer, pulmonary diseases, neurological disorders and heart diseases. Other psychiatric disorders are often comorbid with depressive disorders: alcohol or drug abuse, anxiety disorders and obsessive-compulsive disorder, as well as eating disorders in women. Depression increases by three the risk of cardiac mortality. If depression is not treated, it increases the risk of suicide or other violentactions. The treatment will reduce the risk of suicide to a half, especially in males under 30 years of age. Alcohol or drug abuse, unemployment, social isolation, and impulsivity increase the risk of suicide. Finally, we review the only drugs that have been proved effective in reducing suicidal behavior that are lithium for the risk of suicide in bipolar disorders, and clozapine in the risk of suicide of patients with schizophrenia or schizoaffective disorder (AU)

Manejo de la depresión a largo plazo: la depresión bipolar / Management of long-term depression: bipolar depression

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Depresión a largo plazo en pacientes geriátricos / Long-term depression in geriatric patients

Los ancianos constituyen un grupo de población en el que se encuentra especialmente indicado el tratamiento a largo plazo de la depresión. La tasa de recurrencia oscila entre el 50-90% de los casos en un período de 2 a 3 años. Los factores de riesgo son similares a los que se presentan en adultos más jóvenes, pero la comorbilidad somática, la presencia de afectación cerebro vascular y deterioro cognitivo o la presencia de circunstancias socioeconómicas adversas son especialmente frecuentes entre los ancianos. A pesar de que existen diferencias metodológicas muy notables entre los distintos trabajos en las características clínicas y sociodemográficas de las muestras, diversos estudios avalan el tratamiento de mantenimiento con antidepresivos en la depresión del anciano. La tasa media de recurrencia en los grupos con tratamiento farmacológico activo fue del 29%, mientras que con placebo se sitúa en el 57%. Se recomienda el mantenimiento del tratamiento antidepresivo con la misma sustancia y a la misma dosis de respuesta, con ajustes en función de la respuesta terapéutica, el perfil de tolerancia y las interacciones farmacológicas (AU)

The elderly people are a population group for which long-term treatment of depression is especially indicated. The recurrence rate ranges between 50-90% of cases for a period of two or three years. Risk factors are similar to those of younger adults, but somatic comorbidity, presence of cerebrovascular damage and cognitive impairment, or the existence of adverse socioeconomic situations, are especially frequent among the elderly. In spite of remarkable methodologic differences between the different publications regarding clinical and sociodemographic characteristics of the samples, various studies support the maintenance treatment of depression in the elderly. The mean recurrence rate in those groups with active pharmacological treatment was of 29%, whilst for placebo it was of 57%. Maintenance of the antidepressive treatment with the same substance and at the same response dose is recommended, adjusting it depending on the therapeutic response, tolerance profile and pharmacological interactions (AU)

Manejo a largo plazo de la depresión: recomendaciones finales / Long-term management of depression: final recommendations

Los trastornos afectivos constituyen unas patologías con altas tasas de recurrencia y cronicidad. Existen algunos predictores clínicos.de recurrencia. Los ensayos clinicos alargo plazo (igual o superior a 24 meses) y que incluyen prevención de recaídas y de recurrencias son escasos (11, con un total de 967 pacientes aleatorizados en la fase de mantenimiento). Amitriptilina, imipramina, fenelzina y venlafaxina retard deberían considerarse tratamientos de elección, de acuerdo con los datos proporcionados por estos ensayos clinicos. Determinadas formas de psicoterapia disponen también de estudios positivos con algunos problemas metodológicos importantes. Suicidio, consumo de alcohol y tóxicos, mortalidad cardíaca y comorbilidad con enfermedades médicas son las complicaciones más frecuentes y graves de la depresión a medio y largo plazo. La depresión bipolar implica la necesidad de asociar un estabilizador del ánimo. Los ancianos constituyen un grupo de población caracterizado por la gravedad y recurrencia de los cuadros depresivos (AU)

Affective disorders are conditions with a high rate of relapse and recurrence. There are specific predictors of recurrence. Clinical trials with 24 month at least as duration with prevention of relapses and recurrence are scare (11with a total sample of 967 randomized patients in the maintenance phase). Amitriptiline, imipramine, fenelzine and venlafaxine extended release can be considered as a first line treatment according the data from those clinical trials. Some psychotherapies has also positive results with important methodological problems in the design of the studies. Suicide, drug abuse including alcohol and comorbidity with medical disorders are the more severe and frequent long-term complications. A mood stabiliser drugs is necessary in bipolar depression. Elderly people are a population group characterized for the severity and recurrence of depressive episodes (AU)

A brain-derived neurotrophic factor (BDNF) haplotype is associated with antidepressant treatment outcome in mood disorders.

Brain-derived neurotrophic factor (BDNF) has been studied extensively in relation to the susceptibility to mood disorders (MD), although it remains to be clarified whether BDNF is a susceptibility locus for MD phenotypes, including therapeutic response to antidepressants. We have performed a single-marker and haplotype association study of eight TagSNPs polymorphisms in the genomic region containing the BDNF gene in 342 control subjects and 374 patients with MD, and have tested the association with antidepressant treatment outcome. None of the eight single nucleotide polymorphisms (TagSNPs) was significantly associated with MD phenotype after Bonferroni correction. In the single-marker analysis, a SNP was found to be associated with the patient's state of 'remitter' after adequate trial with a single antidepressant phenotype (odds ratio (OR)=2.95; P=0.0025). We also identified a haplotype associated with this phenotype. This study supports the implication of BDNF in antidepressant treatment outcome in MD, with specific association with 5' upstream region of BDNF gene.

Auditory event-related potentials in 50 melancholic patients: increased N100, N200 and P300 latencies and diminished P300 amplitude.

BACKGROUND: To investigate whether there are some differences in Event-Related Potentials (ERP) between melancholic patients and healthy controls. To establish whether there is a relationship between abnormalities of ERP and severity of depression and psychomotor retardation. METHOD: Melancholic depressed patients (N=50) and normal comparison subjects (N=31) were assessed for latencies and interlatencies of N100, N200, N400, latency and amplitude of P300. The ERPs were studied with an 'oddball paradigm' in the auditory modality. Severity of depression was measured by the Hamilton Depression Rating Scale (HDRS) and psychomotor retardation with the Depressive Retardation Rating Scale (DRRS). RESULTS: The melancholic group showed a significantly higher latency in N100 (P<0.001), N200 (P<0.001) and P300 (P<0.001) and a significantly lower P300 amplitude (P<0.001) than healthy controls. No other differences were found either in the latencies of the N400 or in their interlatencies. HDRS and DRRS do not have any significant correlations with amplitude or latency measures. LIMITATIONS: The subjects of this study are inpatients, with a severe subcategory of depression and high average age. It is difficult to generalize these findings. CONCLUSIONS: The principal finding of this study is the increase in three of the four latencies measured (N100, N200 and P300) and in the decreased P300 amplitude in melancholic patients compared to normal controls. There is no association between these abnormalities and clinical variables.

Loss of the circadian variation of platelet [3H]imipramine binding in delusional compared with non-delusional endogenously depressed patients.

BACKGROUND: The circadian variations of the serotonin reuptake sites were studied in 16 patients meeting DSM-IV criteria for major depression with melancholia, either with (n=8) or without (n=8) psychotic symptomatology. METHOD: The [3H]imipramine binding sites were measured in platelet samples. RESULTS: While no statistically significant difference was found between the morning (09:00 h) and evening (21:00 h) [3H]imipramine B(max) values in the control group, both the non-delusional and delusional melancholic patients showed higher evening than morning B(max) values, which were only statistically significant in the former. When both diagnostic groups were compared, the delusional patients showed significantly lower [3H]imipramine binding values than the non-delusional patients both in the morning and evening samples. Within the non-delusional depressed patients, those individuals with mood circadian variation, assessed by the 18th item of the HDRS, showed significantly lower B(max) values than those without mood variation. Lowest morning and evening B(max) values were noted in the delusional depressed group without mood variations. CONCLUSIONS: These results suggest that delusional depressions might have a different neurobiological substrate with loss of chronobiological rhythms.

Estudio de la percepción del estilo educativo en el trastorno obsesivo-compulsivo / Study of perceived parental rearing style in the obsessive-compulsive disorder

OBJETIVOS: Estudiar si existen diferencias en la percepción del estilo educativo recibido en la infancia entre un grupo de pacientes con trastorno obsesivo-compulsivo y un grupo de controles sanos, y determinar si puede establecerse alguna relación entre las dimensiones del estilo educativo y el desarrollo de las distintas temáticas obsesivo-compulsivas. MÉTODO: Cuarenta pacientes con diagnóstico de TOC según criterios DSM-IV y 40 controles sanos completaron el EMBU, un cuestionario autoadministrable que valora la percepción del estilo educativo recibido en la infancia. Se compararon las puntuaciones obtenidas por ambos grupos en las diversas dimensiones educativas y se emplearon regresiones logísticas binarias para analizar si la percepción del estilo educativo permitía predecir el desarrollo de síntomas obsesivos específicos. RESULTADOS: Los pacientes obsesivos percibían mayor rechazo en ambos progenitores y menor calidez emocional en sus padres durante la infancia que el grupo control, sin constatarse diferencias en la percepción de sobreprotección parental entre ambos grupos. La presencia de conductas de acumulación se asociaba débilmente a la percepción de una escasa calidez emocional paterna. Ninguna de las dimensiones educativas permitía predecir el desarrollo de otros síntomas obsesivos. CONCLUSIONES: Próximos estudios deben profundizar en el papel que las variables sociales y culturales, como el estilo educativo recibido en la infancia, pueden desempeñar en el desarrollo del trastorno obsesivo-compulsivo, en interacción con factores biológicos y genéticos (AU)