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1.
Artigo em Russo | MEDLINE | ID: mdl-35394727

RESUMO

OBJECTIVE: To provide the CBT-PS method for working with adolescents in the post-suicidal period. MATERIAL AND METHODS: Eleven adolescents who were admitted to a children's department of a Krasnoyarsk outpatient clinic after an incomplete suicide were included in the study. All adolescents had depressive or mixed anxiety-depressive symptoms confirmed by clinical and psychological methods (F32 - 36.3%; F41.2 - 36.3%; F92.0 - 18.2%; F43 - 9.1%). CBT-PS was administered following the relief of the acute condition after drug treatment. RESULTS: A cognitive behavioral therapy (CBT-SP) protocol for working with adolescents attempted suicide was presented. The main focus of emergency therapy at the initial, middle and final stages were pointed out. A working algorithm aimed at resolving an acute suicidal crisis including five tasks was described in detail, i.e. chain analysis, drawing up a safety plan, psychoeducational module, finding reasons for life and conceptualizing the case. The basic principles of planning a therapy strategy and the choice of modules of individual and family skills with regard to their relevance for each specific case were revealed. The steps of therapy aimed at preventing relapse and testing the effectiveness of the acquired skills to cope with a stressful situation in future were described in detail. CONCLUSIONS: CBT-SP is a modern method of working with adolescents attempted suicide. The method based on a cognitive-behavioral model of suicidal behavior appears to have the proven clinical efficacy, with it being quite practical for psychiatrists, psychotherapists and medical psychologists dealing with CBT.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Adolescente , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Criança , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada , Transtorno Depressivo/complicações , Humanos , Tentativa de Suicídio/psicologia , Resultado do Tratamento
2.
PLoS One ; 17(3): e0266402, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35358271

RESUMO

PURPOSE: The passage of the Affordable Care Act in the US resulted in more Americans with health insurance coverage as well as expanded health benefits. However, barriers in accessing health care still exist in the US especially as it relates to some of the most vulnerable Americans including those with depressive disorders. The purpose of this cross-sectional secondary data analysis was to examine the differences in health-related quality of life for individuals with depressive disorders in early years of the implementation of the Affordable Care Act as compared to later years of implementation. METHODS: This study used a repeated cross-sectional design that pooled data from the 2011-2017 Behavioral Risk Factor Surveillance System which is a nationally representative survey of the non-institutionalized U.S. population. Logistic regression models were used to evaluate the before and after impact of the Affordable Care Act on health related quality of life for those with depressive disorders. RESULTS: Those with depressive disorders in early years of implementation of the Affordable Care Act were less likely to report 14 or more days of poor physical health (AOR = 0.96; 95% CI: 0.95, 0.98), were less likely to report 14 or more days of poor mental health (AOR = 0.93; 95% CI: 0.92, 0.94), and less likely to report 14 or more days of overall poor physical and mental health (AOR = 0.93; 95% CI: 0.90, 0.96) as opposed to later years of implementation. CONCLUSIONS: Our results indicate poorer health related quality of life for those with depressive disorders in later years of implementation of the Affordable Care Act. Despite expanded mental health benefits under the Affordable Care Act, those benefits do not always translate into improved access or improved patient-reported outcomes. The federal government needs to comprehensively address mental health services in order to improve patient-reported outcomes and mental health treatment for those with depression.


Assuntos
Transtorno Depressivo , Qualidade de Vida , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Análise de Dados , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Acesso aos Serviços de Saúde , Humanos , Cobertura do Seguro , Seguro Saúde , Medicaid , Patient Protection and Affordable Care Act , Estados Unidos/epidemiologia
3.
Curr Psychiatry Rep ; 24(1): 23-35, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35113313

RESUMO

PURPOSE OF REVIEW: To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders. RECENT FINDINGS: Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high.


Assuntos
Transtorno Depressivo , Jogos de Vídeo , Depressão/terapia , Transtorno Depressivo/terapia , Humanos , Psicoterapia
4.
Psychother Psychosom ; 91(3): 200-209, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35158363

RESUMO

INTRODUCTION: Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL). OBJECTIVE: We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression. METHODS: We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity. PRIMARY OUTCOME: Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination. RESULTS: We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided ps < 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided p = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided p = 0.663). CONCLUSIONS: Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.


Assuntos
Depressão , Transtorno Depressivo , Depressão/terapia , Transtorno Depressivo/terapia , Humanos , Internet , Psicoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Medicine (Baltimore) ; 101(3): e28558, 2022 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-35060514

RESUMO

BACKGROUND: Perimenopausal depressive disorder (PDD) is an affective disorder involving endocrine, neurological, immune, which seriously endangers the physical and mental health of human. Selective serotonin reuptake inhibitors (SSRIs) are the current first-line clinical treatment, have limited efficacy and serious side effects. Acupuncture combined with SSRIs therapy has been widely used clinically because it increases efficacy and reduces side effects. There is a lack of high-quality evidence to assess its efficacy and safety. This study evaluated the effectiveness and safety of acupuncture combined with SSRIs in the treatment of PDD by meta-analysis. METHODS: All randomized controlled trials articles about acupuncture combined with SSRIs treatment of PDD will be searched in databases, such as PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, Wei Pu from the construction of the library to December 16, 2021. According to Cochrane 5.1 Handbook criteria, two researchers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed by using RevMan 5.4 and STATA 16.0 software. RESULTS: This study will summarize the current evidence to evaluate the effectiveness and safety of acupuncture combined with SSRIs for the treatment of PDD. CONCLUSION: The results of this study will provide clinicians with new treatment ideas and bring benefits to most patients. REGISTRATION NUMBER: INPLASY2021120080 (DOI number: 10.37766/inplasy2021.12.0080).


Assuntos
Terapia por Acupuntura , Transtorno Depressivo/terapia , Perimenopausa , Inibidores de Captação de Serotonina/uso terapêutico , Transtorno Depressivo/complicações , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
Hist Psychiatry ; 33(1): 47-64, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35090349

RESUMO

My book From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry charts how melancholia was reconceptualized in the nineteenth century as a modern mood disorder and a precursor to clinical depression. The book shows how this occurred chiefly in two ways. First, the idea of disordered mood as a medical concept was created through the appropriation of language from experimental physiology into the realm of psychopathology. Second, the interplay of statistical and diagnostic practices formed the basis for modern psychiatric classification and facilitated the standardization of melancholia as a psychiatric diagnosis. These developments were key to the reconceptualization of melancholia and the subsequent emergence of clinical depression, and were foundational to modern psychiatric theory and practice.


Assuntos
Transtorno Depressivo , Psiquiatria , Depressão/história , Transtorno Depressivo/história , Transtorno Depressivo/terapia , Humanos , Transtornos do Humor , Psiquiatria/história
7.
Acad Pediatr ; 22(3S): S133-S139, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34648936

RESUMO

OBJECTIVE: Depression quality measures aligned with evidence-based practices require that health care organizations use standardized tools for tracking and monitoring patient-reported symptoms and functioning over time. This study describes challenges and opportunities for reporting 5 HEDIS measures which use electronic clinical data to assess adolescent and perinatal depression care quality. METHODS: Two learning collaboratives were convened with 10 health plans from 5 states to support reporting of the depression measures. We conducted content analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. RESULTS: Health plans used various strategies to collect the clinical data needed to report the measures, including setting up direct data exchange with providers and data aggregators and leveraging data captured in health information exchanges and case management records. Health plans noted several challenges to reporting and performance improvement: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices. CONCLUSIONS: Our findings demonstrate ongoing challenges in collecting and using patient-reported clinical data for health plan quality measurement. Systems to track and improve outcomes for individuals with depression will require significant investments and policy support at the point of care and across the healthcare system.


Assuntos
Transtorno Depressivo , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Humanos , Qualidade da Assistência à Saúde , Estados Unidos
8.
Clin Neurophysiol ; 133: 145-151, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34864511

RESUMO

Electroconvulsive therapy (ECT) was applied for the first time in humans in 1938: after 80 years, it remains conceptually similar today except for modifications of the original protocol aimed to reduce adverse effects (as persistent memory deficits) without losing clinical efficacy. We illustrate the stages of development as well as ups and downs of ECT use in the last eighty years, and the impact that it still maintains for treatment of certain psychiatric conditions. Targeted, individualized and safe noninvasive neuromodulatory interventions are now possible for many neuropsychiatric disorders thanks to repetitive transcranial magnetic stimulation (rTMS) that injects currents in the brain through electromagnetic induction, powerful enough to depolarize cortical neurons and related networks. Although ECT and rTMS differ in basic concepts, mechanisms, tolerability, side effects and acceptability, and beyond their conceptual remoteness (ECT) or proximity (rTMS) to "precision medicine" approaches, the two brain stimulation techniques may be considered as complementary rather than competing in the current treatment of certain neuropsychiatric disorders.


Assuntos
Transtorno Depressivo/terapia , Eletroconvulsoterapia/história , Estimulação Magnética Transcraniana/história , Eletroconvulsoterapia/métodos , História do Século XX , História do Século XXI , Humanos , Estimulação Magnética Transcraniana/métodos
9.
Epilepsia ; 63(2): 316-334, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34866176

RESUMO

The aim of this document is to provide evidence-based recommendations for the medical treatment of depression in adults with epilepsy. The working group consisted of members of an ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Psychiatry, ILAE Executive and the International Bureau for Epilepsy (IBE) representatives. The development of these recommendations is based on a systematic review of studies on the treatment of depression in adults with epilepsy, and a formal adaptation process of existing guidelines and recommendations of treatment of depression outside epilepsy using the ADAPTE process. The systematic review identified 11 studies on drug treatments (788 participants, class of evidence III and IV); 13 studies on psychological treatments (998 participants, class of evidence II, III and IV); and 2 studies comparing sertraline with cognitive behavioral therapy (CBT; 155 participants, class of evidence I and IV). The ADAPTE process identified the World Federation of Societies of Biological Psychiatry guidelines for the biological treatment of unipolar depression as the starting point for the adaptation process. This document focuses on first-line drug treatment, inadequate response to first-line antidepressant treatment, and duration of such treatment and augmentation strategies within the broader context of electroconvulsive therapy, psychological, and other treatments. For mild depressive episodes, psychological interventions are first-line treatments, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications (Level B). SSRIs remain the first-choice medications (Level B) for moderate to severe depressive episodes; however, in patients who are partially or non-responding to first-line treatment, switching to venlafaxine appears legitimate (Level C). Antidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous episodes and should continue even longer in severe depression or in cases of residual symptomatology until such symptoms have subsided.


Assuntos
Transtorno Depressivo , Epilepsia , Adulto , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/etiologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/terapia , Epilepsia/tratamento farmacológico , Epilepsia/terapia , Humanos , Inibidores de Captação de Serotonina/uso terapêutico
10.
Sleep Breath ; 26(1): 397-406, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34046817

RESUMO

PURPOSE: This study aimed to examine the effect of high-intensity interval training (HIIT) on both sleep and cardiorespiratory fitness in patients with depression. METHODS: Using a single pre- and post-test study design with no control group, 82 patients diagnosed with depressive disorders underwent HIIT comprising a total of 24 15-min sessions, three times per week for 8 weeks. Depressive symptoms, sleep quality, and cardiorespiratory fitness were evaluated using the Beck depression inventory-II, the Pittsburgh sleep quality index (PSQI), and cardiopulmonary exercise testing (CPET) in the form of maximum oxygen uptake (VO2 max), respectively. RESULTS: All 82 patients completed the intervention. HIIT training was associated with significant improvements in BDI-II score (diff = - 1.57 [95% CI - 2.40 to - 0.73], P = 0.001), PSQI score (diff = - 1.20 [95% CI - 2.10 to - 0.32], P = 0.008), and CPET VO2 max (diff = 0.95 [95% CI 0.62-1.28], P = 0.001). Effect size calculations revealed that the greatest improvement occurred in CPET VO2 max (Cohen's d = 0.64) and that improvements in the BDI-II and PSQI scores were somewhat smaller in magnitude (Cohen's d = - 0.41 and - 0.30, respectively). Sleep quality improvements were observed in sleep latency, habitual sleep efficiency, and the use of sleep-promoting medications (Cohen's d = 0.18, 0.19, and 0.25, respectively). Change in cardiorespiratory fitness successfully predicted change in sleep quality but not in depressive symptoms. Adverse effects were limited to minor injuries which did not interfere with completion of training. CONCLUSIONS: HIIT training delivered over 8 weeks was associated with improvements in depression symptoms, sleep quality, and cardiorespiratory fitness in patients with depressive disorders.


Assuntos
Aptidão Cardiorrespiratória , Transtorno Depressivo/terapia , Terapia por Exercício , Treinamento Intervalado de Alta Intensidade , Adulto , Feminino , Treinamento Intervalado de Alta Intensidade/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
11.
Community Ment Health J ; 58(2): 343-355, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33864548

RESUMO

Behavioral activation (BA) is a beneficial and relatively cost-effective treatment option for depression. This study utilized a pragmatic randomized controlled research design to investigate whether BA, as compared with treatment as usual (TAU), led to superior treatment effects, when delivered in community mental health settings by retrained community mental health professionals. Patients with depressive disorders (n = 64) were randomly assigned to a 10-session BA (n = 31) or TAU (n = 33) group. The depressive symptoms and behavioral engagement were assessed at the baseline, post-treatment, and a six-month follow-up. Results showed that, as compared to the TAU group, the BA group had: (1) a reduction in depression severity, as evidenced by large effect sizes and greater response rates, and (2) an increase in behavioral engagement. However, the post-treatment gains were not maintained at the six-month follow-up. The implications and limitations of the study are also discussed (KCT0004098, June 27, 2019, retrospectively registered).


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo , Terapia Cognitivo-Comportamental/métodos , Depressão/psicologia , Transtorno Depressivo/terapia , Custos de Cuidados de Saúde , Humanos , Resultado do Tratamento
12.
Psychother Psychosom Med Psychol ; 72(1): 45-49, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34488236

RESUMO

Our goal was to present current research on the effectiveness, acceptance and safety of technology-based psychological interventions (TBIs) for bridging waiting periods (e. g., for outpatient psychotherapy) and aftercare of people with depressive disorders and to derive implications for future research. In this systematic review of 83 studies, the use of TBIs in people with diagnosed depression was analyzed. Among these, only a few studies were identified as those applying TBIs for bridging waiting periods (n=1) and aftercare (n=4). The narrative summary of results suggests the effectiveness of TBIs for aftercare. However, very few data are available on TBIs regarding their acceptance, safety and use for bridging waiting periods. The current evidence base is insufficient for recommending the use of TBIs for bridging waiting periods and for aftercare. Further randomized controlled trials capturing effectiveness, acceptance, safety, and the potential for implementation of TBIs under real-world care conditions are needed.


Assuntos
Assistência ao Convalescente , Transtorno Depressivo , Depressão , Transtorno Depressivo/terapia , Humanos , Intervenção Psicossocial , Psicoterapia , Tecnologia
14.
J Psychopharmacol ; 35(12): 1536-1541, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34872405

RESUMO

BACKGROUND: Potentiating current antidepressant treatment is much needed. Based on animal studies, caffeine may augment the effects of currently available antidepressants. OBJECTIVE: Here, we tested whether habitual caffeine consumption moderates the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) using intermittent theta-burst stimulation (iTBS). METHODS: Forty patients with current depressive episodes were randomized to active iTBS (n = 19) or sham treatment (n = 21; shielded side of the coil and weak transcutaneous electrical stimulation) delivered two times per day for 10-15 weekdays. Neuronavigated stimulation was applied to the dorsomedial prefrontal cortex. Symptom improvement was measured using change in self-reported Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Pretreatment habitual caffeine consumption was quantified using self-reports of number of cups of coffee and energy drinks consumed the 2 days before the treatment starts. RESULTS: Habitual caffeine consumption was associated with symptom improvement following active iTBS (r = 0.51, 95% confidence interval (CI): 0.08-0.78, p = 0.025) but not following sham treatment (r = -0.02, 95% CI: -0.45 to 0.42, p = 0.938). A multiple regression analysis corroborated the findings by showing a significant caffeine consumption × treatment group interaction (ß = 0.62, p = 0.043), but no main effects of treatment group (ß = 0.22, p = 0.140) or caffeine consumption (ß = -0.01, p = 0.948). No group differences in pretreatment symptom scores or caffeine consumption were detected (p values > 0.86). CONCLUSION: Habitual caffeine consumption moderated the antidepressant effect of dorsomedial iTBS, consistent with caffeine improving antidepressant pharmacological treatments in animals. Caffeine is an antagonist of adenosine receptors and may enhance antidepressant effects through downstream dopaminergic targets.


Assuntos
Cafeína/farmacologia , Transtorno Depressivo/terapia , Córtex Pré-Frontal , Antagonistas de Receptores Purinérgicos P1/farmacologia , Estimulação Magnética Transcraniana , Adolescente , Adulto , Cafeína/administração & dosagem , Café , Terapia Combinada , Transtorno Depressivo/tratamento farmacológico , Método Duplo-Cego , Comportamento de Ingestão de Líquido/fisiologia , Bebidas Energéticas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/fisiopatologia , Antagonistas de Receptores Purinérgicos P1/administração & dosagem , Adulto Jovem
15.
BMJ Open ; 11(12): e050098, 2021 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-34907048

RESUMO

INTRODUCTION: Depression is characterised by easy recurrence, high disability and high burden, and antidepressant therapy is the standard treatment. However, its treatment effect on patients with severe depressive disorder has been unsatisfactory. Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS), as a neurotherapy, can effectively mitigate the severity of depressive symptoms. Yet, more evidence is still required for TMS to treat severe depression. This study will be the first systematic review of the efficacy and tolerability of TMS for treating severe depression. We expect it to guide future clinical practice of TMS for the treatment of psychiatric disorders. METHODS AND ANALYSIS: We will search for the randomised controlled trial (RCT) involving rTMS for treating depression in eight electronic databases, including PubMed, Web of Science, EMBASE, the Cochrane Library and Wanfang Database, from publication up to September 2021. We will define Improvement in depressive symptoms, the difference between pretreatment (baseline) and post-treatment as the primary outcomes. The difference between pretreatment and post-treatment changes in resting state fMRI will be regarded as the secondary outcomes. Quality assessment of the included articles will be independently performed according to the Cochrane Risk of Bias tool. ETHICS AND DISSEMINATION: Ethical approval is not essential because there is no need to collect individual patient data. And this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: CRD42020211460.


Assuntos
Transtorno Depressivo , Estimulação Magnética Transcraniana , Depressão/terapia , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Estimulação Magnética Transcraniana/métodos
16.
J Oleo Sci ; 70(11): 1539-1550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34732633

RESUMO

Unipolar depression has been recognized as one of the major diseases by the World Health Organization in the 21st century. The etiology of depression is complicated and includes genetic factors, stress, aging, and special physical status (pregnancy, metabolic syndrome, and trauma). Numerous animal and human studies have demonstrated that n-3 polyunsaturated fatty acids (n-3 PUFAs) are highly correlated to cognition and depression. These nutritional antidepressants, including EPA and DHA, have a range of neurobiological activities contributing to their potential antidepressant effects. Our preclinical and clinical studies have indicated that n-3 PUFA supplementation in addition to standard antidepressant medications may provide synergistic neuroprotective and antioxidant/inflammatory effects. To translate our preliminary findings into clinical application, this paper reviews the existing evidence on the antidepressant effects of n-3 PUFAs and the potential underlying mechanisms, which include modulation of chronic lowgrade inflammation and the corresponding changes in peripheral blood immune biomarkers.


Assuntos
Anti-Inflamatórios , Transtorno Depressivo/terapia , Suplementos Nutricionais , Óleos de Peixe/administração & dosagem , Animais , Antidepressivos/administração & dosagem , Antioxidantes , Transtorno Depressivo/etiologia , Transtorno Depressivo/imunologia , Ácidos Docosa-Hexaenoicos/administração & dosagem , Ácido Eicosapentaenoico/administração & dosagem , Ácidos Graxos Ômega-3/administração & dosagem , Óleos de Peixe/química , Óleos de Peixe/farmacologia , Humanos , Neuroprostanos
17.
J Clin Psychiatry ; 83(1)2021 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-34792870

RESUMO

Objective: Electroconvulsive therapy (ECT)-emergent hypomania/mania is a clinically significant problem that has lacked evidence-based guidelines for effective management. The aim of this systematic literature review is to compile the current published literature on treating ECT-emergent hypomania/mania to help guide treatment course in patients with unipolar and bipolar depression.Data Sources: MEDLINE/PubMed was searched for studies published from 1980 through August 2020 that evaluated the treatment of ECT-emergent hypomania/mania. Search terms included Boolean combinations of the following: mania, hypomania, ECT, ECT induced mania, and ECT induced hypomania.Study Selection: There were 1,662 articles reviewed, and all published studies detailing the treatment of ECT-emergent hypomania/mania written in English that met inclusion criteria were included. Due to the limited number of articles, there were no restrictions.Data Extraction: Two reviewers extracted relevant articles and assessed each study based on inclusion criteria.Results: The literature review identified 12 articles that described the treatment course of ECT-emergent hypomania/mania in 17 patients. There were 9 patients who had no known history of manic or hypomanic episodes and were diagnosed with unipolar depression and 8 patients diagnosed with bipolar disorder. There were 4 primary treatment courses identified: continuing ECT alone, continuing ECT in conjunction with lithium, discontinuing ECT with no medication treatment, or discontinuing ECT and starting a medication.Conclusions: The available data are insufficient to support definitive conclusions; however, potential treatment guidelines are suggested within the review to providers based on the limited data available.


Assuntos
Eletroconvulsoterapia/efeitos adversos , Mania/terapia , Adolescente , Adulto , Idoso , Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Mania/etiologia , Pessoa de Meia-Idade , Adulto Jovem
18.
Transl Psychiatry ; 11(1): 531, 2021 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-34657142

RESUMO

Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.


Assuntos
Transtorno Depressivo , Transtorno Depressivo/terapia , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
BMC Psychiatry ; 21(1): 504, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34649534

RESUMO

BACKGROUND: Up to one in eight women experience depression during pregnancy. In the UK, low intensity cognitive behavioural therapy (CBT) is the main psychological treatment offered for those with mild or moderate depression and is recommended during the perinatal period, however referral by midwives and take up of treatment by pregnant women is extremely low. Interpersonal Counselling (IPC) is a brief, low-intensity form of Interpersonal Psychotherapy (IPT) that focuses on areas of concern to service users during pregnancy. To improve psychological treatment for depression during pregnancy, the study aimed to assess the feasibility and acceptability of a trial of IPC for antenatal depression in routine NHS services compared to low intensity perinatal specific CBT. METHODS: We conducted a small randomised controlled trial in two centres. A total of 52 pregnant women with mild or moderate depression were randomised to receive 6 sessions of IPC or perinatal specific CBT. Treatment was provided by 12 junior mental health workers (jMHW). The primary outcome was the number of women recruited to the point of randomisation. Secondary outcomes included maternal mood, couple functioning, attachment, functioning, treatment adherence, and participant and staff acceptability. RESULTS: The study was feasible and acceptable. Recruitment was successful through scanning clinics, only 6 of the 52 women were recruited through midwives. 71% of women in IPC completed treatment. Women reported IPC was acceptable, and supervisors reported high treatment competence in IPC arm by jMHWs. Outcome measures indicated there was improvement in mood in both groups (Change in EPDS score IPC 4.4 (s.d. 5.1) and CBT 4.0 (s.d. 4.8). CONCLUSIONS: This was a feasibility study and was not large enough to detect important differences between IPC and perinatal specific CBT. A full-scale trial of IPC for antenatal depression in routine IAPT services is feasible. TRIAL REGISTRATION: This study has been registered with ISRCTN registry 11513120 . - date of registration 05/04/2018.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo , Aconselhamento , Depressão/terapia , Transtorno Depressivo/terapia , Feminino , Humanos , Gravidez , Resultado do Tratamento
20.
Saudi Med J ; 42(10): 1117-1124, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34611007

RESUMO

OBJECTIVES: To investigate the degree of public awareness, beliefs, and attitudes regarding major depression and available treatment options in the Saudi population. METHODS: A community-based cross-sectional study of 1,188 participants was carried out from March to April 2021 in Ha'il, Saudi Arabia using an online self-administered questionnaire. Using a snowball sampling technique, the authors targeted the Saudi population living in Ha'il region. RESULTS: Overall, 65.6% of the participants had good awareness regarding depression disorder in total. Of the participants, 72.9% had good awareness regarding general awareness, 85.4% regarding depression symptoms, 12.3% regarding risk factors, and 15.7% regarding treatments. Of the participants, 67.3% believed that depression was caused by lack of faith and 45.5% believed that depression was caused by "the evil eye" or black magic. Of the participants, 56% believed in faith healers as a legitimate treatment approach. Of the participants, 63.9% were willing to work with individuals with depression, 62.7% were willing to establish friendships with them, and 27.9% believed that individuals with depression had weak personalities. CONCLUSION: The general population exhibited good general awareness regarding depression and its symptoms, but knowledge of risk factors and treatments was poor. Our findings underscore the need for public educational programs to increase public awareness about the risk factors and treatment options for depression.


Assuntos
Transtorno Depressivo , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Humanos , Arábia Saudita/epidemiologia , Inquéritos e Questionários
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