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1.
Zhonghua Yi Xue Za Zhi ; 100(3): 197-201, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008286

RESUMO

Objective: To explore the efficacy, adverse reactions, feasibility, and acceptability of transcranial alternating current stimulation (tACS) treating drug-naive adult patients with major depressive disorder (MDD), and provide basis for further study with a large sample. Methods: The study was performed in the Neuromodulation laboratory, Department of Neurology of Xuanwu Hospital, Capital Medical University (Beijing, China) from July, 2017 to June, 2018. Thirty Eligible first-episode MDD outpatients were randomized 1∶1 to receive active tACS or sham intervention. The tACS was administered in a 40 minute, 77.5 Hz frequency, 15 mA session with one forehead (Fp1, Fpz, and Fp2, in the 10/20 international placement system, 4.45 cm×9.53 cm) and two mastoid (3.18 cm×3.81 cm) stimulation for 20 times in 4 consecutive weeks at fixed day time frame once daily from Monday through Friday, with weekends off (week 4), followed by 4 weeks with no tACS treatment (week 8). By utilizing the Hamilton rating scale for depression-17 item (HRSD-17) to assess the depressive severity of MDD patients, adverse events were administered by the treatment-emergent adverse events, the Young mania rating scale, and the self-made common questionnaire on cranial electrical stimulation. The primary efficacy outcome was the remission rate defined as HRSD-17 score ≤7 at week 8. Secondary outcomes included the rates of remission at week 4 and response at weeks 4 and 8. Safety was assessed by evaluation of adverse events. Also the proportions of participants accepting the intervention and this study procedure were evaluated at weeks 4 and 8. Results: Thirty MDD patients completed the study, and both groups had no statistical differences on their demographic characteristics (P>0.05). At week 8, the active group had a remission rate of 10/15, which was higher than 3/15 in the sham group (P<0.05). Also, the remission rate (14/15) in the active group was higher than 5/15 of the sham group at week 4 (P<0.05). For the response rates, significant differences were found between groups at week 8. For safety, both groups showed no severe adverse events and no mania/hypomania. One participant per group had 2 times of tinnitus cerebri during the intervention days. All patients accepted the intervention and the study procedure. Conclusions: The pilot study indicated that tACS with 77.5 Hz and 15 mA may have a therapeutic effect on depressive symptoms. It is well-tolerated and safe, as well as feasible and acceptable for adults with MDD.


Assuntos
Transtorno Depressivo Maior , Estimulação Transcraniana por Corrente Contínua , Adulto , China , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Humanos , Projetos Piloto , Resultado do Tratamento
2.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002932

RESUMO

Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Humanos
3.
Orv Hetil ; 161(1): 3-10, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31884813

RESUMO

The rapidly evolving field of repetitive transcranial magnetic stimulation as a neuromodulational technique may mean a safe, alternative approach to the management of several mental disorders, especially treatment-resistant major depressive disorder. Our aim is to describe the current role of transcranial magnetic stimulation in research and routine clinical practice, based on the literature and clinical protocols. Since the discovery, that an outer magnetic source can depolarize neurons, both neurology and psychiatry seek the method's possible clinical utility. To date, in the field of psychiatry, the method is only approved in the treatment of major depressive disorder and obsessive-compulsive disorder, but research continues to find application in other mental disorders (schizophrenia, bipolar disorder), too. The next step in the evolution of repetitive transcranial magnetic stimulation is based on magnetic resonance guided, real-time navigation with the help of positioning algorithms. The so-called neuronavigational systems make precise aiming of neuronal circuits responsible for the development of depression, thus increasing the excitability of the left dorsolateral prefrontal cortex and decreasing it on the right hemisphere. The method has few contraindications, and the occurrence of side effects can be minimized by carefully selected patient population. For today, transcranial magnetic stimulation became an evidence-based, effective treatment for some mental disorders, especially treatment-resistant major depressive disorder. It is to be assumed that in the future neuronavigational neuromodulation techniques, including repetitive transcranial magnetic stimulation, will be widely used in the field of psychiatry and neurology. Magnetic stimulation is currently available in a number of centres in Hungary, but the financial approval and the implementation of this neuromodulation method for treating mental disorders in the everyday clinical practice are still in progress. Orv Hetil. 2020; 161(1): 3-10.


Assuntos
Transtorno Depressivo Maior/terapia , Estimulação Magnética Transcraniana/métodos , Transtorno Depressivo Maior/psicologia , Humanos , Hungria , Córtex Pré-Frontal , Estimulação Magnética Transcraniana/efeitos adversos , Resultado do Tratamento
4.
Lancet Psychiatry ; 7(1): 29-40, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860455

RESUMO

BACKGROUND: Stimulation adjustment is required to optimise outcomes of deep brain stimulation (DBS) for treatment-resistant depression, but controlled data for ideal stimulation parameters are poor or insufficient. We aimed to establish the efficacy and safety of short pulse width (SPW) and long pulse width (LPW) subcallosal cingulate DBS in depression. METHODS: We did a double-blind, randomised, crossover trial in an academic hospital in Calgary, AB, Canada. Patients had DSM IV-defined major depressive disorder and bipolar depression (20-70 years old, both sexes) and did not respond to treatment for more than 1 year, with a score of 20 or more on the 17-item Hamilton Depression Rating Scale (HDRS) at recruitment. Patients underwent bilateral DBS implantation into the subcallosal cingulate white matter using diffusion tensor imaging tractography. Patients were randomly assigned 1:1 without stratification using a computerised list generator to receive either SPW (90 µs) or LPW (210-450 µs) stimulation for 6 months. Patients and the clinician assessing outcomes were masked to the stimulation group. Keeping frequency constant (130 Hz), either pulse width or voltage was increased monthly, based on response using the HDRS. Patients who did not respond to treatment (<50% reduction in HDRS from baseline) at 6 months crossed over to the opposite stimulation for another 6 months. All patients received individualised cognitive behavioural therapy (CBT) for 12 weeks. The primary outcome was change in HDRS at 6 months and 12 months using intention-to-treat analysis. This study is registered with ClinicalTrials.gov, NCT01983904. FINDINGS: Between Dec 5, 2013, and Sept 30, 2016, of 225 patients screened for eligibility, 23 patients were selected for DBS surgery. After one patient withdrew, 22 (mean age 46·4 years, SEM 3·1; 10 [45%] female, 12 [55%] male) were randomly assigned, ten (45%) to LPW stimulation and 12 (55%) to SPW stimulation. Patients were followed up at 6 months and 12 months. There was a significant reduction in HDRS scores (p<0·0001) with no difference between SPW and LPW groups (p=0·54) in the randomisation phase at 6 months. Crossover groups did not show a significant decrease in HDRS within groups (p=0·15) and between groups (p=0·21) from 6-12 months. Adverse events were equal between groups. Worsening anxiety and depression were the most common psychological adverse events. One patient in the SPW group died by suicide. INTERPRETATION: Both LPW and SPW stimulation of subcallosal cingulate white matter tracts carried similar risks and were equally effective in reducing depressive symptoms, suggesting a role for both pulse width and amplitude titration in optimising clinical outcomes in patients with treatment-resistant depression. FUNDING: Alberta Innovates Health Solutions.


Assuntos
Transtorno Bipolar/terapia , Estimulação Encefálica Profunda , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Imagem de Tensor de Difusão , Córtex Pré-Frontal , Canadá , Terapia Cognitivo-Comportamental , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Adv Exp Med Biol ; 1180: 1-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784955

RESUMO

Depressive disorder is one of the most widespread forms of mental disorders which lead to a significant public health concern, such as disability, suicide, and so on. Its etiology remains vague but it is believed that depressive disorder is a multifactorial disease which is induced by the interaction of social, psychological, and biological factors. Thus, there is no clear and definite pathological theory could illustrate its mechanism independently until now, involving genetics, neuroimaging, neuroinflammation, neuroendocrine, and others. Comprehensive assessment to patients with depression is the starting point for a right diagnosis. History-taking of physical condition is as important as psychiatric interview and rational usage of scales would be beneficial for screening. There are many kinds of therapeutic measures for depressive patients nowadays, including general intervention, pharmacotherapy, psychotherapy, and physical therapy. For now, anti-depressants used in clinical practice is almost monoamine-based drugs while much more progress have been made in developing new antidepressant medications, like prototypical N-methyl-D-aspartate (NMDA) receptor antagonists, opioid agonists, gamma-aminobutyric acid (GABAA) receptors, and psychedelics. Once these novel drugs are proved to be practicable, it will create a historical evolution in the field of psychiatry. In addition, we advocate that measurement-based care (MBC) should run through the whole duration of treatment and goals of MBC in every stage are different. As brain projects in many countries are conducting in inspiring ways, we believe that our understanding about depressive disorder, of course, and other neuropsychiatric disorders will be better in the future.


Assuntos
Depressão/terapia , Transtorno Depressivo Maior/terapia , Antidepressivos/uso terapêutico , Humanos , Psicoterapia
6.
Adv Exp Med Biol ; 1180: 99-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784959

RESUMO

Enormous efforts for near half-century have harvested a plenty of understanding on major depressive disorder (MDD), although the underlying mechanisms are still elusive. The available antidepressants are far from satisfaction due to long-delay action (LDA) of antidepressant efficacy and low response rates in MDD patients. Notably, discovery of a single low-dose ketamine-producing rapid-onset and sustained antidepressant efficacy has inspired new research direction. These new studies have revealed ketamine's NMDAR-dependent and NMDAR-independent mechanisms, most of which are well known to be the key bases of synaptic plasticity as well as learning and memory. In fact, animal models of MDD are all based on the principle of learning and memory, i.e., the change of a behavior, for which monoaminergic and glutamatergic systems are the major modulators and executors, respectively. Reconsidering MDD as an aberrant form of emotion-related learning and memory would endow us a clearer research direction for developing new techniques or ways to prevent, diagnose, and treat MDD.


Assuntos
Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Plasticidade Neuronal , Animais , Antidepressivos/uso terapêutico , Humanos , Ketamina/uso terapêutico
7.
Adv Exp Med Biol ; 1180: 117-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784960

RESUMO

Most processes of human body, such as brain function, are regulated by biological rhythms. Disturbance of biological rhythms impairs mood, behavior, cognition, sleep, and social activity and may lead to mental disorders. Disturbed rhythms are widely observable in patients with major depressive disorders (MDD) and make risk of onset, comorbidity, response of antidepressants, recurrence, cognition, social function, and complications of physical health. Therefore, it is crucial to assess and manage focus on biological rhythms for patients with MDD. There are several validated ways of assessing the biological rhythms, including 24 h fluctuations in cortisol or melatonin, sleep monitoring, actigraphy, and self-report scales. Chronotherapy, such as cognitive-behavioral therapy, interpersonal and social rhythm therapy, sleep deprivation, and bright light therapy was widely reported for treatment in patients with MDD. Monoamine antidepressants and lithium are attributed to regulation of biological rhythm. And some rhythm-regulated agents have been shown efficacy of antidepressant. Considering the crucial clinical significance of disturbed biological rhythms in MDD, we describe the mechanisms, clinical features, measurements, and treatments of the biological rhythms in patients with MDD.


Assuntos
Ritmo Circadiano , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Humanos , Hidrocortisona/fisiologia , Melatonina/fisiologia , Sono
8.
Adv Exp Med Biol ; 1180: 193-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784964

RESUMO

The treatment strategies of depressive disorder include pharmacological treatment, psychotherapy, and physical therapy (electroconvulsive therapy [ECT], transcranial magnetic stimulation [TMS], etc.). The updated CANMAT guidelines recommended the most second-generation antidepressants as first-line treatments for patients with a major depressive disorder (MDD) of moderate or greater severity. Before antidepressant treatment, comprehensive assessment and safety monitoring are necessary. The application of measurement-based care in the diagnosis and treatment of depression would better ensure that enough dosage and response of antidepressant is achieved at each key point, and the final outcome of disease is improved. It is recommended that antidepressant is used with monotherapy in patients with depression. Antidepressants of different types and different mechanisms could be combined to improve the efficacy for patients with treatment-resistant depression (TRD). To prevent the relapse and recurrence of disease, the long-term treatment comprised of acute treatment, consolidation treatment, and maintenance treatment must be considered for all patients.


Assuntos
Transtorno Depressivo Maior/terapia , Antidepressivos/uso terapêutico , Eletroconvulsoterapia , Humanos , Psicoterapia , Estimulação Magnética Transcraniana , Resultado do Tratamento
9.
Adv Exp Med Biol ; 1180: 201-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784965

RESUMO

Despite many advances in pharmacotherapy over the past half centurye, only a fraction of patients with Major Depressive Disorder (MDD) can achieve remission after the first or second trial of pharmacotherapy. Those who failed standard antidepressant treatment are termed as Treatment-Resistant Depression (TRD). Pharmacotherapy for TRD is more viable over past 15 years in part due to advances in clinical trials such as the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) and the US Department of Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study. In general, optimizing pharmacotherapy consists of switching to different agents, combination with different antidepressants, or augmentation with different class of psychotropic medications, and the latter is preferred. Augmenting agents with strong evidence include Bupropion, Lithium, Triiodothyronine (T3), Aripiprazole, Brexpiprazole, Quetiapine, and Olanzapine in combination with Fluoxetine. Many works need to be done to further advance this field. These include (1) Establish agreement on a standardized, systematic, and feasible definition of TRD, (2) Establish safety and tolerability beyond acute treatment phase, (3) Establish individual psychosocial and neurobiological marks such as pharmacogenetic variance, and (4) Utilize multi-treatment modules such as combination of psychotherapy and pharmacotherapy in conjunction with brain stimulation therapy such as electroconvulsive therapy, vagus nerve stimulation and transcranial magnetic stimulation; as well as non-traditional therapy such as nutritional supplements, exercise and light therapy.


Assuntos
Transtorno Depressivo Maior/terapia , Antidepressivos/uso terapêutico , Quimioterapia Combinada , Eletroconvulsoterapia , Humanos , Psicoterapia , Estimulação Magnética Transcraniana , Resultado do Tratamento
10.
Adv Exp Med Biol ; 1180: 277-295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784969

RESUMO

Numerous antidepressants are available for the treatment of the major depressive disorder (MDD). Unfortunately, the disadvantages of these antidepressive medications, including inadequate treatment response, the therapeutic lag between drug administration and the onset of symptoms alleviation, and the safety consideration limit their clinical use and accelerate the exploration of advanced antidepressants with novel action mechanisms/newer targets, with fewer side effects. In this chapter, a series of compounds showing clinical potent in the treatment of MDD has been reviewed based on their reported results from different phase clinical trials. Although the majority of these strategies currently only lead to a systematic approach in the aspects of treatment resistant depression, some of them would be a routine clinical practice which is usable in the treatment of MDD, such as ketamine. Additionally, beyond the mechanism of action for novel therapeutic molecules involving glutamatergic, opiate, cholinergic receptors, and neuroplasticity, some supplemental procedures such as polyunsaturated fatty acids were also included in this chapter due to their solid property against MDD.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Ensaios Clínicos como Assunto , Humanos
11.
Medicine (Baltimore) ; 98(51): e18473, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861028

RESUMO

BACKGROUND: The aim of this study is to determine the efficacy of preemptive analgesia with paracetamol and ibuprofen to reduce the intensity and incidence of headache and myalgia after electroconvulsive therapy (ECT). METHODS: Sixty patients with major depression who were treated with ECT were randomized to receive ECT 3 times a week. The first 3 sessions were included in the study. The patients were divided into 3 groups; Group C (Control, Saline, n = 20), Group P (Paracetamol, n = 20), and Group I (Ibuprofen, n = 20). Demographics, duration of seizure, visual analog scale (VAS) for headache and myalgia and nausea, vomiting and pruritus were evaluated at postoperative 24 hours period. RESULTS: Duration of seizure after ECT was similar in all groups (P = .148). In the study, heart rate and mean arterial pressure were found to be some changes in some of the sessions. There were no significant differences in any comparison for all groups in all sessions regarding VAS scores for headache and myalgia. Incidence of headache and myalgia in Group I was lower than the other groups (P = .233, P = .011, respectively). But, there was no significant difference between the other groups. There was no significant difference in vomiting, intergroups, and intragroup. CONCLUSIONS: The findings of our study indicate that pain intensity of headache and myalgia did not show a significant change between groups and within groups. While pain intensity of myalgia between the groups reached no statistical significance, ibuprofen was significantly lowered the incidence of myalgia at postoperative 24 hours period.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Eletroconvulsoterapia/efeitos adversos , Cefaleia/prevenção & controle , Mialgia/prevenção & controle , Acetaminofen/administração & dosagem , Adulto , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Feminino , Cefaleia/etiologia , Humanos , Ibuprofeno/administração & dosagem , Masculino , Pessoa de Meia-Idade , Mialgia/etiologia , Adulto Jovem
12.
Psychiatr Hung ; 34(4): 359-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31767796

RESUMO

The risk of suicidal behaviour in mood disorders is an inherent severity of the depressive episode. Suicidal behaviour in patients with mood disorders is both state and severity dependent, which means that suicidality markedly decreases or vanishes after clinical recovery. However, since the majority of mood disorder patients never commit or attempt suicide, special clinical characteristics of the illness, as well as some personality, familial and psycho-social factors should also play a contributory role. This paper discusses the clinically explorable suicide risk factors in patients with major mood disorders, with particular regard to the underlying bipolarity. Successful acute and longterm pharmacotherapy - supplemented by psycho-social interventions - markedly reduces the risk of attempted and completed suicide, even in this high-risk population. Keywords: major depressive disorder; bipolar disorders.


Assuntos
Transtorno Bipolar/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Suicídio/psicologia , Transtorno Bipolar/terapia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Humanos , Fatores de Risco , Ideação Suicida , Tentativa de Suicídio/psicologia
13.
Psychiatr Hung ; 34(4): 369-379, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767797

RESUMO

In this literature review the new trends of cognitive behavioural therapy (CBT), namely behavioural activation and rumination-focused cognitive behavioural therapy are introduced as new methods for the treatment of major depression. Component-analytical studies of CBT showed that besides cognitive restructuring, behavioural components play an important role as active treatment factors. Behavioural activation and rumination-focused CBT emphasize these processes. The central idea of behavioural activation is that negative experiences in depression result in secondary avoidant behaviour. Clients participating in such therapy learn to recognize and change avoidant behaviour. Rumination-focused CBT target repetitive negative thoughts that are considered a transdiagnostic maladaptive phenomenon. These conceptual and methodological can contribute substantially to the effectiveness of CBT for major depression.


Assuntos
Terapia Cognitivo-Comportamental , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Aprendizagem da Esquiva , Humanos , Ruminação Cognitiva , Resultado do Tratamento
15.
Psychiatr Danub ; 31(Suppl 3): 411-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488762

RESUMO

BACKGROUND: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health? SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12). RESULTS: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2=6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health. CONCLUSION: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Nível de Saúde , Inibidores de Captação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Aliança Terapêutica , Citalopram/uso terapêutico , Método Duplo-Cego , Cloridrato de Duloxetina/uso terapêutico , Humanos
16.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401578

RESUMO

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington's disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.


Assuntos
Transtorno Depressivo Maior/terapia , Progressão da Doença , Eletroconvulsoterapia/efeitos adversos , Doença de Huntington/psicologia , Ansiedade/complicações , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Doença de Huntington/complicações , Pessoa de Meia-Idade
17.
J Consult Clin Psychol ; 87(9): 787-801, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31403815

RESUMO

OBJECTIVE: Loneliness is a key public health issue for which various interventions have been trialed. However, few directly target the core feature of loneliness-lack of belonging. This is the focus of Groups 4 Health (G4H), a recently developed intervention that targets the development and maintenance of social group memberships to support health. METHOD: To investigate the efficacy of this intervention, a randomized controlled trial was conducted with participants (N = 120) assigned to G4H or treatment-as-usual (TAU) by computer software. Assessment of primary (loneliness) and secondary (depression, social anxiety, general practitioner visits, multiple group membership) outcomes was conducted at baseline and 2-month follow-up using mixed-model repeated-measures analyses. RESULTS: G4H produced a greater reduction in loneliness (d = -1.04) and social anxiety (d = -0.46) than TAU (d = -0.33 and d = 0.03, respectively). G4H was also associated with fewer general practitioner visits at follow-up (d = -0.33) and a stronger sense of belonging to multiple groups (d = 0.52) relative to TAU (d = 0.30 and d = 0.33, respectively). Depression declined significantly in both G4H (d = -0.63) and TAU (d = -0.34), but follow-up analyses showed this was greater in G4H among those not receiving adjunct psychopharmacological treatment and whose symptoms were milder. CONCLUSIONS: Findings suggest that G4H can be a useful way to treat loneliness and highlight the importance of attending to group memberships when tackling this important social challenge. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/terapia , Processos Grupais , Solidão , Psicoterapia/métodos , Identificação Social , Estresse Psicológico/terapia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fobia Social/terapia , Resultado do Tratamento , Adulto Jovem
18.
Lancet Psychiatry ; 6(9): 735-744, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31371212

RESUMO

BACKGROUND: Medication is commonly used to treat youth depression, but whether medication should be added to cognitive behavioural therapy (CBT) as first-line treatment is unclear. We aimed to examine whether combined treatment with CBT and fluoxetine was more effective than CBT and placebo in youth with moderate-to-severe major depressive disorder. METHODS: The Youth Depression Alleviation-Combined Treatment (YoDA-C) trial was a randomised, double-blind, placebo-controlled, multicentre clinical trial. Participants were aged 15-25 years with moderate-to-severe MDD and had sought care at one of four clinical centres in metropolitan Melbourne, Australia. Patients were randomly assigned (1:1) to receive CBT for 12 weeks, plus either fluoxetine or placebo. Participants began on one 20 mg capsule of fluoxetine or one placebo pill per day. All participants received CBT, delivered by therapists in weekly 50-minute sessions and attended interviews at baseline, and at weeks 4, 8, and 12, during which they completed assessments with research assistants. Participants saw a psychiatrist or psychiatry trainee to complete medical assessments at the same timepoints. The primary outcome was change in the interviewer-rated Montgomery-Åsberg Depression Rating Scale (MADRS) score at 12 weeks. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001281886). FINDINGS: 153 participants (mean age 19·6 years [SD 2·7]) were enrolled from Feb 20, 2013, to Dec 13, 2016. 77 (50%) patients were allocated to CBT and placebo and 76 (50%) to CBT and fluoxetine. Participants had severe depression at baseline (mean MADRS score 33·6 [SD 5·1] in the CBT and placebo group and 32·2 [5·6] in the CBT and fluoxetine group), with high proportions of participants with anxiety disorder comorbidity (47 [61%] in the CBT and placebo group and 49 [64%] in the CBT and fluoxetine group) and past-month suicidal ideation (55 [71%] in the CBT and placebo group and 59 [78%] in the CBT and fluoxetine group). 59 (77%) participants in the CBT and placebo group and 64 (84%) in the CBT and fluoxetine group completed follow-up at week 12. After 12 weeks of treatment both groups showed a reduction in MADRS scores (-13·7, 95% CI -16·0 to -11·4, in the CBT and placebo group and -15·1, -17·4 to -12·9, in the CBT and fluoxetine group). There was no significant between-group difference in MADRS scores (-1·4, -4·7 to 1·8; p=0·39). There were five suicide attempts in the CBT and placebo group and one suicide attempt in the CBT and fluoxetine group (odds ratio 0·2, 0·0-1·8; p=0·21), and no significant between-group differences for other suicidal behaviours. INTERPRETATION: We did not find evidence that the addition of fluoxetine (rather than placebo) to CBT further reduced depressive symptoms in young people with moderate-to-severe MDD. Exploratory analyses showed that the addition of medication might be helpful for patients with comorbid anxiety symptoms and for older youth. FUNDING: Australian National Health and Medical Research Council.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Combinada/métodos , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Fluoxetina/uso terapêutico , Adolescente , Adulto , Ansiedade/complicações , Ansiedade/tratamento farmacológico , Ansiedade/terapia , Austrália/epidemiologia , Comorbidade , Depressão/terapia , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Feminino , Fluoxetina/administração & dosagem , Humanos , Masculino , Inibidores de Captação de Serotonina/uso terapêutico , Ideação Suicida , Resultado do Tratamento , Adulto Jovem
19.
Curr Sports Med Rep ; 18(8): 299-304, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389872

RESUMO

Depression is a leading cause of global burden. The mainstay of treatment is pharmacological and psychological interventions. While effective, not all people will respond to those treatments and alternative approaches for preventing and treating depression are required. Recent literature has demonstrated that higher physical activity (PA) levels and exercise confer protective effects on incident depression. Also, exercise has demonstrated efficacy on reducing symptoms for people with depression. Despite its effectiveness, similar to other treatments, some people may benefit more from exercise and identifying these potential predictors of response is necessary to deal with patients' and professionals' expectations. Dropout from exercise interventions is comparable to dropout from other treatments for depression and similar to dropout from exercise in other clinical populations. However, some strategies to increase adherence are important. In the present article, we provide an updated overview of the use of PA and exercise for the prevention and treatment of depression.


Assuntos
Depressão/prevenção & controle , Depressão/terapia , Exercício , Transtorno Depressivo Maior/terapia , Humanos
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