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1.
World Neurosurg ; 133: 278-282, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606510

RESUMO

BACKGROUND: Depression following resection of diffuse low-grade glioma has rarely been described. Location of the tumor and surgical route are potential causes. Lesion network mapping (LNM), leveraging high-quality resting-state functional magnetic resonance imaging data from large samples of healthy adults, has been used to explore the broader network connectivity for given lesions. However, LNM has not been applied to large intra-axial masses or surgical lesions. We used LNM to examine a potential cause of postoperative depression in a patient with a cingulate diffuse low-grade glioma (zones I-III). CASE DESCRIPTION: A 34-year-old woman underwent surgery for medically refractory seizures attributable to diffuse low-grade glioma. Near-total resection was attained via a single-stage, transcortical route through the medial prefrontal cortex. Despite freedom from seizure and lack of tumor growth at 42 months of follow-up, she developed symptoms of major depressive disorder soon after surgery that persisted. To identify functional networks potentially engaged by the surgical corridor and tumor resection cavity, both were segmented separately and used as seeds for normative resting-state functional magnetic resonance imaging connectivity mapping. To study depression specifically, networks associated with the tumor and surgical approach were compared with networks associated with subgenual cingulate deep brain stimulation. LNM results suggested that the surgical corridor, rather than the tumor, had greater overlap with deep brain stimulation-based depression networks (32% vs. 8%). CONCLUSIONS: Early postoperative development of major depressive disorder following resection of a cingulate region tumor, although likely multifactorial, should be considered and patients appropriately counseled preoperatively. Further validation of LNM as a viable methodology for correlating symptoms to lesions could make it a valuable tool in selection of surgical approach and patient counseling.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Transtorno Depressivo Maior/etiologia , Glioma/cirurgia , Giro do Cíngulo/cirurgia , Convulsões/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Feminino , Glioma/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Convulsões/etiologia
2.
Psychiatr Hung ; 35(1): 46-57, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-31854322

RESUMO

The authors summarize the last 10 years of an ongoing collaborative study between the Universities of Szeged and Pittsburgh on early onset major depression. First, the "Risk factors of childhood depression" grant is presented briefly as an initial research study in which the subjects of the current studies were recruited. This is a prominently large clinical sample in the field of child psychiatry even on an international level. In addition to the follow-up of the prognosis of the disorder, recent studies continue to explore the early onset depression in two directions. On the one hand, two studies investigate the role of biobehavioral inflexibility markers in the development of major depression ("Biobehavioral inflexibility and risk for juvenile-onset depression" and "Biobehavioral inflexibility and risk for juvenile-onset depression - renewal grant"). On the other hand, the authors would like to have a better understanding of the possible relationship between the major depression and cardiovascular diseases ("Pediatric depression and subsequent cardiac risk factors: a longitudinal study"). The most significant aims of the three studies will be demonstrated, as well as how the studies were prepared and organized along with the already existing experience concerning research management and involvement of new collaborating partners and experts.


Assuntos
Pesquisa Biomédica/economia , Depressão , Transtorno Depressivo Maior , Organização do Financiamento/tendências , Pesquisa Biomédica/organização & administração , Criança , Depressão/etiologia , Transtorno Depressivo Maior/etiologia , Humanos , Estudos Longitudinais , Fatores de Risco , Universidades/organização & administração
3.
Diabetes Metab Syndr ; 13(4): 2375-2380, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405646

RESUMO

AIM: Diabetes increases the odds of depression and depression is often associated with poor glycemic control and complications of diabetes. Vitamin D is also believed to improve glycemic control and ameliorate depressive symptoms. Therefore, we examined effects of vitamin D monotherapy (without antidepressant drugs) on depressive symptoms in Type 2 diabetic patients with mild to moderate depressive symptoms. METHODS: We conducted 12 weeks, placebo-controlled, double-blind, randomized trial on 68 subjects with T2DM and mild to moderate depressive symptoms. Subjects received 100 µg (4000 IU) vitamin D (n = 32) or placebo (n = 34) daily. Beck Depression Inventory-II (BDI-II-PERSIAN) was applied for assessment of the severity of depression. Depression scores and metabolic profiles were measured at the beginning and end of trail. RESULTS: after 3 months of vitamin D supplementation, mean values of 25(OH) D increased from 15.5 ±â€¯8.8 to 32.2 ±â€¯8.9 ng/ml (p-value <0.001) in the vitamin D group. Moreover, BDI-II scores decreased from 15.2 ±â€¯9.6 to 9.8 ±â€¯7.2 (p-value <0.001) in the vitamin D group and 15.5 ±â€¯11.2 to 13.7 ±â€¯11.5 (p-value = 0.03) in placebo group. This decrease in BDI-II scores were significant (27.6% vs 10.8%) compared with placebo (p-value = 0.02). In term of metabolic profiles, mean change in level of Hemoglobin A1c (HbA1c), insulin and triglycerides (TG) were significantly higher in response to the treatment with vitamin D compared to placebo (p-value <0.02). CONCLUSIONS: In conclusion, supplementation of vitamin D in T2DM patients may protect these patients against the onset of major depressive disorder (MDD), with noticeable favorable effects on measures of metabolic profiles. TRIAL REGISTRATION: NCT03008057.


Assuntos
Transtorno Depressivo Maior/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Suplementos Nutricionais , Deficiência de Vitamina D/fisiopatologia , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Biomarcadores/análise , Glicemia/análise , Transtorno Depressivo Maior/etiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
5.
Diabetes Metab Syndr ; 13(2): 1475-1479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336509

RESUMO

Efficacious adherence to treatment protocol predicts metabolic control among Type 2 diabetics (T2DM) [1-4]; however, few healthcare systems employ individualized strategies to mediate the comorbidity of T2DM with other chronic disease states. A clinically prescribed ketogenic diet, patient-centered nutritional education and high intensity interval training (HIIT), girded by solution-focused psychotherapy, modulate significant improvements in the clinical biomarkers associated with concurring T2DM and clinical depression [5-15]. Relevant metabolic change was noted in the following measures: HOMA-IR, triglyceride/HDL ratio, HgA1c, fasting insulin, fasting glucose, fasting triglycerides, LDL, VLDL, HDL, total cholesterol and C-reactive protein. The Patient Health Questionnaire 9 (PHQ-9) along with clinical interview and the mental status exam showed notable change in the patient's depressive symptoms; likewise, her self-efficacy score normalized, as measured by the General Self-Efficacy Questionnaire (GSE) and the Metabolic Syndrome Compliance Questionnaire (MSC). The case study highlights a 65-year old female who presented with a 26-year history of dually-diagnosed Type 2 diabetes (T2DM) and major depressive disorder (MDD). The patient was prescribed a ketogenic diet (KD), clinically formulated from her resting metabolic rate, body fat percentage and lean body mass, together with weekly nutrition education, high intensity interval training (matched to her cardiovascular conditioning), and eight 45-minute solution-focused psychotherapy sessions. Intervention goals included improved insulin sensitivity evaluated by the HOMA-IR, sustained glycemic control measured via HgA1c, reduced cardiovascular risk via the triglyceride/HDL ratio, and improved depressive symptoms with increased self-efficacy monitored by the PHQ-9 and GSE/MSC. The results of the 12-week intervention were statistically significant. The patient's HgA1c dropped out of diabetic range (8.0%) and normalized at 5.4%. Her average daily glucose measurements declined from 216 mg/dL to 96 mg/dL; the HOMA-IR and triglyceride/HDL ratios improved by 75%. Her marker for clinical depression and measurement of self-efficacy normalized. The 12-week individualized treatment intervention served to functionally reverse 26 years of T2DM, ameliorate two and half decades of chronic depressive disorder and empower/equip the patient with a new experience of hope and success.


Assuntos
Transtorno Depressivo Maior/prevenção & controle , Diabetes Mellitus Tipo 2/dietoterapia , Dieta Cetogênica , Idoso , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Prognóstico
6.
Artigo em Inglês | MEDLINE | ID: mdl-31349552

RESUMO

Background: individuals with type 2 diabetes show emotional distress as they learn how to cope with the disease. The emotional distress increases the possibility of complications in these patients. The aims of the present study were to evaluate the impact of the emotional distress in the quality of life of individuals with diabetes, and to investigate the demographic and clinical characteristics associated with the emotional distress of living with diabetes in a Mexican population. Methods: a total of 422 Mexican individuals with type 2 diabetes were recruited from the outpatient Diabetes Clinic of the Hospital Regional de Alta Especialidad Dr. Gustavo A. Rovirosa of Villahermosa, Tabasco. Demographic and clinical characteristics along with quality of life (SF-36) were assessed in these individuals. The emotional distress of living with diabetes was measured using the 5-item Problem Areas in Diabetes. Patients were divided according to the presence of high or low distress. Results: we identified that 31.8% (n = 134) of patients presented high diabetes-related emotional distress. We observed that hepatic diseases as comorbidities (p = 0.008) and diagnosis of major depression (p = 0.04) are factors associated with the emotional distress of living with diabetes. These patients showed a reduced quality of life in all dimensions (p < 0.001); the most affected dimensions were physical role (d = 0.37) and general health (d = 0.89) showing lower scores in comparison with patients with low emotional distress. Conclusions: our results suggest that Mexican individuals with type 2 diabetes mellitus show high emotional distress living with the disease and have a decreased quality of life. Therefore, it is necessary to decrease factors associated with the high emotional distress of living with diabetes in patients with type 2 diabetes.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Diabetes Mellitus Tipo 2/psicologia , Nível de Saúde , Qualidade de Vida/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
7.
J Korean Med Sci ; 34(26): e181, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31269543

RESUMO

BACKGROUND: Panic disorder (PD) and major depressive disorder (MDD) can occur concurrently, despite different clinical manifestations. Because MDD and PD patients tend to have more complicated conditions, understanding the co-occurrence and pattern of these conditions is important. Here, we investigated the influence of PD and MDD on each other, with respect to time interval. METHODS: Data from three national representative surveys were pooled (total 18,807 respondents), and the age of onset (AOO) of PD and MDD was analyzed. We performed Kaplan-Meier analysis to estimate separate survival functions, using the AOO of MDD and PD as the outcome. To understand the temporal effect of other disorders, we used a Cox proportional hazard model to estimate the hazard ratios for the onset of MDD/PD with other comorbidities as time-dependent covariates. RESULTS: PD elevated the risk of subsequent MDD by 1.5-fold, whereas MDD elevated the risk of subsequent PD by 3.8-fold. The effect of such an elevation risk was significant for up to 2 years. CONCLUSION: The results revealed a bidirectional relationship between MDD and PD. Each disease represents a risk of a subsequent occurrence of the other, which lasts for a considerable duration.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno de Pânico/diagnóstico , Adulto , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/complicações , Transtorno de Pânico/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
9.
East Asian Arch Psychiatry ; 29(2): 66-70, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237249

RESUMO

OBJECTIVE: To investigate association between major depressive disorder (MDD) and quality of life in patients with neurological disorder. METHODS: This cross-sectional study was carried out at a Malaysian hospital between April 2016 and December 2016 using convenience sampling. Patients aged ≥18 years with intracranial tumour or other brain disorders were invited to participate. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire version 3.0; diagnosis of MDD was made using Mini International Neuropsychiatric Interview. RESULTS: Of 122 patients approached, 100 (66 women and 34 men) were included (response rate, 93.5%), with a mean age of 45.3 years. The prevalence of MDD in patients with neurological disorder was 30%. Compared with non-depressed patients, patients with MDD had poorer global health status / quality of life (p = 0.003), and reduced physical (p = 0.003), role (p = 0.021), emotional (p < 0.001), cognitive (p = 0.004), and social (p = 0.007) functioning, as well as more symptoms of fatigue (p = 0.004), pain (p < 0.001), dyspnoea (p = 0.033), insomnia (p < 0.001), appetite loss (p = 0.002), constipation (p = 0.034), diarrhoea (p = 0.021), and financial difficulties (p = 0.039). CONCLUSION: Patients with MDD had reduced quality of life. Fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties were prevalent among patients with MDD.


Assuntos
Transtorno Depressivo Maior , Doenças do Sistema Nervoso , Qualidade de Vida , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/psicologia , Prevalência , Pesquisa Qualitativa
10.
Genomics Proteomics Bioinformatics ; 17(2): 183-189, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31233833

RESUMO

Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 µM) was significantly higher than that of the controls (9.73 µM, P < 0.001, Mann-Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood-brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Hipersensibilidade Alimentar/complicações , Imunoglobulina G/imunologia , Adolescente , Biomarcadores/sangue , Proteína C-Reativa , Doença Crônica , Citocinas , Transtorno Depressivo Maior/sangue , Feminino , Hipersensibilidade Alimentar/sangue , Histamina/sangue , Homocisteína/sangue , Humanos , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Mediadores da Inflamação/sangue , Masculino , Fatores de Risco , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Adulto Jovem
11.
Twin Res Hum Genet ; 22(3): 140-146, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31203833

RESUMO

We sought to investigate the risk of incident major depressive disorder (MDD) attributable to a range of sleep disorders in the Danish population. Data were obtained by linking longitudinal Danish population-based registers. A total of 65,739 individuals who had first onset of depression between 1995 and 2013 were selected as cases. For each case, a set of 20 controls of the same sex, birth month and year and who had not had depression by the date that the case was diagnosed were selected at random form the population (N = 1,307,580 in total). We examined whether there was an increased rate of prior sleep disorders in MDD cases compared to controls using conditional logistic regression. An increased risk of incident depression in cases was found for all sleep disorders analyzed. Highest incidence rate ratios (IRRs) were found for circadian rhythm disorders (IRR = 7.06 [2.78-17.91]) and insomnia of inorganic origin (IRR = 6.76 [4.37-10.46]). The lowest estimated IRR was for narcolepsy (IRR = 2.00 [1.26-3.17]). Those diagnosed with a sleep disorder in the last 6 months were at highest risk of developing depression compared to those with at least 1 year since diagnosis (3.10 vs. 2.36). Our results suggest that having any sleep disorder is a risk factor for incident depression. Depression screening should be considered for patients with sleep disorders, and where possible, long-term follow-up for mental health problems is advisable.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Transtornos do Sono-Vigília/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
12.
BMC Cancer ; 19(1): 466, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101016

RESUMO

BACKGROUND: The prevalence and factors associated with major depressive disorder (MDD) among adults with cancer have been documented in the scientific literature. However, this data is limited among children and adolescents with cancer; especially in low resource settings such as Uganda. We assessed the prevalence and factors associated with MDD in children and adolescents attending the Uganda cancer institute out-patient clinic. METHODS: This was a cross-sectional study in which three hundred and fifty-two children and adolescents with any cancer diagnosis were screened for depression using the Child Depression Inventory (CDI) and evaluated with the mini neuropsychiatric interview for children and adolescents (MINI-KID). Associated factors were assessed using a standardized questionnaire that assessed child and caregiver demographic and psychosocial characteristics. Multiple logistic regression models were used to assess factors independently associated with MDD. RESULTS: Of the 352 children and adolescents recruited in the study 134(38%) scored above a cut-off point of 13 on the CDI indicating significant depression symptoms. However, 91(26%) met criteria for MDD. The majority of those with MDD (n = 59 64.8%) had CDI scores of 13-19 indicating mild depression, 30(33%) had scores of 20-25 indicating moderate depression and 2(2.2%) had scores of 25 and above indicating severe depression. Protective factors against MDD were having a special person in the respondent's life (p = 0.002) and using self-distraction as a coping method (p = < 0.001). Risk factors were being an adolescent(p = < 0.001). CONCLUSION: The prevalence of MDD is substantial in children and adolescents with cancer in Uganda. Given that the majority had a mild-moderate depression, there is an urgent need to integrate psychotherapy-the first-line treatment for depression into the routine care of children and adolescents with cancer.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Neoplasias/complicações , Adolescente , Criança , Estudos Transversais , Depressão , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Neoplasias/psicologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Uganda/epidemiologia
13.
Braz J Psychiatry ; 41(5): 433-436, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994857

RESUMO

OBJECTIVE: To evaluate the association between social and health contextual variables, and between major depressive episodes (MDE) and suicidal thoughts in Brazilian adults. METHODS: This population-based cross-sectional study used data from the 2013 National Health Survey (Pesquisa Nacional de Saúde). The Patient Health Questionnaire was used to evaluate the presence of MDE and suicidal thoughts. We used number of Family Health Strategy teams (FHS) per 20,000 state population, number of Psychosocial Care Centers (Centros de Atenção Psicossocial [CAPS]) per 1,000 state population, gross domestic product (GDP), and Gini index for each Brazilian state as contextual variables. Multilevel logistic regression models were used to calculate OR and the intraclass correlation coefficient (ICC). RESULTS: Prevalence of MDE and suicidal thoughts was 4.1% (95%CI 3.8-4.4) and 3.8% (95%CI 3.5-4.1), respectively. Multilevel regression models showed an ICC of 1.1% for MDE (95%CI 0.5-2.3) and 1.3% for suicidal thoughts (95%CI 0.6-2.6). Neither GDP, Gini, FHS, or CAPS showed evidence of association with the outcomes. CONCLUSIONS: In general, contextual variables, within each Brazilian state, do not seem to affect the prevalence of MDE and suicidal thoughts.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Ideação Suicida , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
Nat Commun ; 10(1): 1941, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-31028273

RESUMO

Mendelian randomization (MR) has emerged as a major tool for the investigation of causal relationship among traits, utilizing results from large-scale genome-wide association studies. Bias due to horizontal pleiotropy, however, remains a major concern. We propose a novel approach for robust and efficient MR analysis using large number of genetic instruments, based on a novel spike-detection algorithm under a normal-mixture model for underlying effect-size distributions. Simulations show that the new method, MRMix, provides nearly unbiased or/and less biased estimates of causal effects compared to alternative methods and can achieve higher efficiency than comparably robust estimators. Application of MRMix to publicly available datasets leads to notable observations, including identification of causal effects of BMI and age-at-menarche on the risk of breast cancer; no causal effect of HDL and triglycerides on the risk of coronary artery disease; a strong detrimental effect of BMI on the risk of major depressive disorder.


Assuntos
Algoritmos , Neoplasias da Mama/genética , Doença da Artéria Coronariana/genética , Transtorno Depressivo Maior/genética , Genoma Humano , Análise da Randomização Mendeliana/estatística & dados numéricos , Fatores Etários , Índice de Massa Corporal , Neoplasias da Mama/sangue , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , HDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Conjuntos de Dados como Assunto , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/etiologia , Feminino , Estudo de Associação Genômica Ampla , Humanos , Menarca/sangue , Menarca/genética , Característica Quantitativa Herdável , Fatores de Risco , Triglicerídeos/sangue
15.
BMC Psychiatry ; 19(1): 100, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917802

RESUMO

BACKGROUND: Depression is a common complication of traumatic brain injury (TBI). New evidence suggests that antidepressant medication may be no more effective than placebo in this population. MAIN BODY: Selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in contemporary expert consensus clinical practice guidelines for management of TBI. This recommendation is based on multiple prior meta-analyses of clinical trials in depression after TBI as well as depression in the general population. The evidence is mixed. A recent clinical trial and new meta-analysis including that trial found no benefit of antidepressants for depression following TBI. We argue that this finding should not change practice, i.e., patients who present with depression after TBI should still be considered for antidepressant treatment, because they may (1) benefit from robust placebo effects, (2) benefit from an alternative or adjunctive medication if the agent prescribed first does not achieve a depression remission, and (3) make improvements that are not captured well by traditional depression outcome measures, which are confounded by TBI sequelae. Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. CONCLUSION: TBI, and especially mild TBI, is not a contraindication for antidepressant therapy. Health providers should routinely screen and initiate treatment for depression after TBI.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Antidepressivos/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Ensaios Clínicos como Assunto , Depressão/etiologia , Transtorno Depressivo Maior/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Captação de Serotonina/uso terapêutico
16.
Eur Neuropsychopharmacol ; 29(3): 349-355, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30704794

RESUMO

Major depressive disorder (MDD) is a leading cause of disability and inability to work. There is evidence that occupational factors may precipitate a MDD episode and interfere with the recovery process. In a previous investigation, we found that those employed in high occupational levels had a worse outcome after treatment for depression (Mandelli et al., 2016). The aim of the present study was to further investigate response to treatments for depression according to occupational status on an independent sample of MDD patients. Six hundred and forty-seven (647) subjects with a stable working occupation were taken from a larger independent sample of MDD patients evaluated for response and resistance to treatment for depression, after at least one adequate treatment trial. Three broad occupational categories were considered: 'manager', 'white-collar', 'blue-collar' and 'self-employed'. Managers had the highest rate of non-response and resistance to treatments. White-collar workers also had high non-response and resistance rates. At the opposite, Blue-collar workers had significantly lower rates of non-response and resistance. Self-employed were in between White- and Blue-collar workers and did not significantly differ from the other occupational categories. The findings of this replication study substantially support our previous observations. MDD patients employed in high-middle occupations may have a less favorable outcome after standard treatments of depression. Working stressful condition and other psychosocial factors at work should be investigated more closely in relation to treatment outcomes in MDD.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Emprego , Estresse Ocupacional/fisiopatologia , Ocupações , Adulto , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Resistência a Medicamentos , Feminino , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco
17.
Braz J Psychiatry ; 41(5): 396-402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30758433

RESUMO

OBJECTIVE: To assess the prevalence of depression and sociodemographic, behavioral, and health-related risk factors therefor in a southern Brazilian city. METHODS: Population-based, cross-sectional study of adults from Rio Grande, state of Rio Grande do Sul, Brazil. Individuals (n=1,295) were selected using a multistage sampling procedure. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for major depressive episodes (MDEs). We used a conceptual causal framework to organize and assess risk factors for MDE and calculated prevalence ratios (PR) using regression models. RESULTS: The prevalence of MDE was 8.4% (95%CI 6.0-10.7) for men and 13.4% (95%CI 11.0-15.8) for women. For men, physical inactivity (PR 2.34, 95%CI 1.09-5.00) and perceived stress (PR 20.35, 95%CI 5.92-69.96) were associated with MDE. In women, MDE prevalence was higher among those in the first tertile of economic index (PR 2.61, 95%CI 1.53-4.45), with 0-8 years of schooling (PR 2.25, 95%CI 1.24-4.11), alcohol users (PR 1.91, 95%CI 1.21-3.02), those physically inactive (PR 2.49, 95%CI 1.22-5.09), with the highest perceived stress (PR 9.17, 95%CI 3.47-24.23), with another mental disorder (PR 1.85, 95%CI 1.32-2.59), and with more noncommunicable diseases (PR 1.85, 95%CI 1.06-3.22). CONCLUSION: Women had a higher prevalence of depression, and socioeconomic disadvantages were important for the occurrence of MDE; however, for men, only physical inactivity and stress were important predictors, suggesting possible different causal pathways for each sex.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
J Endocrinol Invest ; 42(8): 881-888, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30788770

RESUMO

BACKGROUND: Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE: To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS: 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS: The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS: Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.


Assuntos
Sintomas Afetivos/etiologia , Depressão/classificação , Transtorno Depressivo Maior/etiologia , Diabetes Mellitus Tipo 2/complicações , Adulto , Estudos de Casos e Controles , Depressão/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
19.
J Affect Disord ; 249: 315-318, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30802696

RESUMO

BACKGROUND: Past studies suggest that brexpiprazole is an effective adjunctive treatment for major depressive disorder and schizophrenia; however, no studies have examined brexpiprazole for bipolar depression. In this study, we examined the effects of brexpiprazole on mood, cognition, and quality of life in outpatients with bipolar depression. METHODS: Twenty-one adults with bipolar disorder (most recent episode depressed) and scoring at least a 25 on the Montgomery-Åsberg Depression Rating Scale (MADRS) were recruited. Brexpiprazole was titrated up to 4 mg/day over the 8-week period. Depressive symptoms were measured using MADRS and Inventory of Depressive Symptomatology Self-report (IDS-SR30). Manic symptoms were measured using Young Mania Rating Scale, quality of life with the Quality of Life in Bipolar Disorder (QOLBD), and cognition with Rey Auditory Verbal Learning Test, Stroop Color Word Test, and Trail Making Test. RESULTS: MADRS and IDS-SR30 scores decreased from baseline at weeks 4 and 8. YMRS and cognitive scores did not change significantly. QOLBD scores increased from baseline to week 8. LIMITATIONS: A limitation to this study is the open-label design. CONCLUSION: To our knowledge, this is the first study to examine the effects of brexpiprazole on bipolar depression. We found a significant reduction in depressive symptoms and an increase in quality of life.


Assuntos
Antidepressivos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Qualidade de Vida/psicologia , Quinolonas/administração & dosagem , Tiofenos/administração & dosagem , Adulto , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Cognição/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Humor Irritável/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
20.
Transl Psychiatry ; 9(1): 14, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718454

RESUMO

Stress is associated with poorer physical and mental health. To improve our understanding of this link, we performed genome-wide association studies (GWAS) of depressive symptoms and genome-wide by environment interaction studies (GWEIS) of depressive symptoms and stressful life events (SLE) in two UK population-based cohorts (Generation Scotland and UK Biobank). No SNP was individually significant in either GWAS, but gene-based tests identified six genes associated with depressive symptoms in UK Biobank (DCC, ACSS3, DRD2, STAG1, FOXP2 and KYNU; p < 2.77 × 10-6). Two SNPs with genome-wide significant GxE effects were identified by GWEIS in Generation Scotland: rs12789145 (53-kb downstream PIWIL4; p = 4.95 × 10-9; total SLE) and rs17070072 (intronic to ZCCHC2; p = 1.46 × 10-8; dependent SLE). A third locus upstream CYLC2 (rs12000047 and rs12005200, p < 2.00 × 10-8; dependent SLE) when the joint effect of the SNP main and GxE effects was considered. GWEIS gene-based tests identified: MTNR1B with GxE effect with dependent SLE in Generation Scotland; and PHF2 with the joint effect in UK Biobank (p < 2.77 × 10-6). Polygenic risk scores (PRSs) analyses incorporating GxE effects improved the prediction of depressive symptom scores, when using weights derived from either the UK Biobank GWAS of depressive symptoms (p = 0.01) or the PGC GWAS of major depressive disorder (p = 5.91 × 10-3). Using an independent sample, PRS derived using GWEIS GxE effects provided evidence of shared aetiologies between depressive symptoms and schizotypal personality, heart disease and COPD. Further such studies are required and may result in improved treatments for depression and other stress-related conditions.


Assuntos
Depressão/genética , Transtorno Depressivo Maior/genética , Acontecimentos que Mudam a Vida , Herança Multifatorial , Polimorfismo de Nucleotídeo Único , Bancos de Espécimes Biológicos , Estudos de Coortes , Depressão/etiologia , Transtorno Depressivo Maior/etiologia , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Masculino , Análise de Regressão , Escócia , Reino Unido
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