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Treatment resistant bipolar depression

Giulio Perugi, Pierpaolo Medd, Pierpaolo Medd, Cristina Toni, Michela Giorgi Mariani, Chiara Socci, Mauro Mauri
OBJECTIVE: We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features. METHOD: 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features...
October 17, 2016: Current Neuropharmacology
Edward C Lauterbach
Dextromethorphan (DM) may have ketamine-like rapid-acting, treatment-resistant, and conventional antidepressant effects.(1,2) This reports our initial experience with DM in unipolar Major Depressive Disorder (MDD). A patient with treatment-resistant MDD (failing adequate trials of citalopram and vortioxetine) with loss of antidepressant response (to fluoxetine and bupropion) twice experienced a rapid-acting antidepressant effect within 48 hours of DM administration and lasting 7 days, sustained up to 20 days with daily administration, then gradually developing labile loss of antidepressant response over the ensuing 7 days...
August 15, 2016: Psychopharmacology Bulletin
Rodrigo B Mansur, Juhie Ahmed, Danielle S Cha, Hanna O Woldeyohannes, Mehala Subramaniapillai, Julie Lovshin, Jung G Lee, Jae-Hon Lee, Elisa Brietzke, Eva Z Reininghaus, Kang Sim, Maj Vinberg, Natalie Rasgon, Tomas Hajek, Roger S McIntyre
BACKGROUND: There is a paucity of treatments that are capable of reliably and robustly improving cognitive function in adults with mood disorders. Glucagon-like peptide-1 is synthesized centrally and its receptors are abundantly expressed in neural circuits subserving cognitive function. We aimed to determine the effects of liraglutide, a GLP-1 receptor (GLP-1R) agonist, on objective measures of cognition in adults with a depressive or bipolar disorder. METHODS: In this 4-week, pilot, open-label, domain-based study (e...
October 1, 2016: Journal of Affective Disorders
Amy McKeever, SueEllen Alderman, Stephanie Luff, Brian DeJesus
Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians...
October 2016: Nursing for Women's Health
Minkyung Park, Laura E Newman, Philip W Gold, David A Luckenbaugh, Peixiong Yuan, Rodrigo Machado-Vieira, Carlos A Zarate
Several pro-inflammatory cytokines have been implicated in depression and in antidepressant response. This exploratory analysis assessed: 1) the extent to which baseline cytokine levels predicted positive antidepressant response to ketamine; 2) whether ketamine responders experienced acute changes in cytokine levels not observed in non-responders; and 3) whether ketamine lowered levels of pro-inflammatory cytokines, analogous to the impact of other antidepressants. Data from double-blind, placebo-controlled studies of patients with major depressive disorder (MDD) or bipolar disorder (BD) who received a single infusion of sub-anesthetic dose ketamine were used (N = 80)...
September 30, 2016: Journal of Psychiatric Research
Kuanqing Mi
The multifactorial etiology of major affective disorders, such as major depression and bipolar disorder, poses a challenge for identification of effective treatments. In a substantial number of patients, psychopharmacologic treatment does not lead to effective continuous symptom relief. The use of deep brain stimulation (DBS) for treatment-resistant patients is an investigational approach that has recently produced promising results. The recent development of safer stereotaxic neurosurgery, and the combination with functional neuroimaging to map the affected brain circuits, have led to the investigation of DBS as a potential strategy to treat major mood disorders...
October 2016: Experimental and Therapeutic Medicine
P A Geoffroy, J-A Micoulaud Franchi, R Lopez, I Poirot, A Brion, S Royant-Parola, B Etain
OBJECTIVES: Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. METHODS: We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: "bipolar disorder" and ("sleep" or "insomnia" or "hypersomnia" or "circadian" or "apnoea" or "apnea" or "restless legs")...
September 23, 2016: L'Encéphale
A Rigal, S Mouchabac, C S Peretti
INTRODUCTION: The number of patients with depression in the world is 350 millions according to estimates. The search for new treatments, particularly in forms of resistant depression, is necessary given the growing number of patients experiencing treatment failure and resistance. Scopolamine, an anticholinergic antimuscarinic molecule, is one of the treatments under evaluation. It falls within the assumptions of cholinergic disruption of the pathophysiology of depression, at different levels (genetic, receptorial [muscarinic and glutamate receptors], hormonal, synaptic…)...
September 9, 2016: L'Encéphale
Joshua D Rosenblat, Roger S McIntyre
Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined mixed features are highly prevalent in bipolar disorder (BD), affecting ~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5-defined mixed features...
September 13, 2016: CNS Spectrums
Aron Tendler, Noam Barnea Ygael, Yiftach Roth, Abraham Zangen
Deep transcranial magnetic stimulation (dTMS) utilizes different H-coils to study and treat a variety of psychiatric and neurological conditions with identifiable brain targets. The availability of this technology is dramatically changing the practice of psychiatry and neurology as it provides a safe and effective way to treat even drug-resistant patients. However, up until now, no effort was made to summarize the different types of H-coils that are available, and the conditions for which they were tested. Areas covered: Here we assembled all peer reviewed publication that used one of the H-coils, together with illustrations of the effective field they generate within the brain...
October 2016: Expert Review of Medical Devices
Masaki Fujiwara, Masatoshi Inagaki, Yuji Higuchi, Yosuke Uchitomi, Seishi Terada, Masafumi Kodama, Yoshiki Kishi, Norihito Yamada
Repetitive transcranial magnetic stimulation (rTMS) has been reported to be a new treatment option for treatment-resistant depression. In Japan, there has been limited research into its feasibility, efficacy, and tolerability. We have launched a trial of rTMS for treating medication-resistant major depressive disorder and bipolar depression. We are investigating low-frequency rTMS to the right dorsolateral prefrontal cortex and traditional high-frequency rTMS to the left dorsolateral prefrontal cortex, in 20 patients...
August 2016: Acta Medica Okayama
Tsuyoshi Sasaki, Kenji Hashimoto, Yasunori Oda, Tamaki Ishima, Madoka Yakita, Tsutomu Kurata, Masaru Kunou, Jumpei Takahashi, Yu Kamata, Atsushi Kimura, Tomihisa Niitsu, Hideki Komatsu, Tadashi Hasegawa, Akihiro Shiina, Tasuku Hashimoto, Nobuhisa Kanahara, Eiji Shimizu, Masaomi Iyo
OBJECTIVE: 'Treatment-resistant depression' is depression that does not respond to an adequate regimen of evidence-based treatment. Treatment-resistant depression frequently becomes chronic. Children with treatment-resistant depression might also develop bipolar disorder (BD). The objective of this study was to determine whether serum levels of oxytocin (OXT) in treatment-resistant depression in adolescents (TRDIA) differ from non-treatment-resistant depression in adolescents (non-TRDIA) or controls...
2016: PloS One
Cassandra Joslyn, David J Hawes, Caroline Hunt, Philip B Mitchell
OBJECTIVES: To identify clinical characteristics and adverse outcomes associated with an earlier age of onset of bipolar disorder. METHODS: A comprehensive search yielded 15 empirical papers comparing clinical presentation and outcomes in individuals with bipolar disorder grouped according to age of onset (total N=7370). The following variables were examined to determine odds ratios (ORs) and 95% confidence intervals (CIs): presence of Axis I comorbidity, rapid cycling, psychotic symptoms, mixed episodes (DSM-IV), lifetime suicide attempts, lifetime alcohol and substance abuse, symptom severity, and treatment delay...
August 2016: Bipolar Disorders
Rafael T de Sousa, Alexandre A Loch, André F Carvalho, André R Brunoni, Marie Reine Haddad, Ioline D Henter, Carlos A Zarate, Rodrigo Machado-Vieira
Both bipolar disorder (BD) and major depressive disorder (MDD) have high morbidity and share a genetic background. Treatment options for these mood disorders are currently suboptimal for many patients; however, specific genetic variables may be involved in both pathophysiology and response to treatment. Glutamatergic agents such as the N-methyl-D-aspartate (NMDA) antagonist ketamine are effective in treatment-resistant mood disorders, underscoring the potential importance of the glutamatergic system as a target for improved therapeutics...
August 11, 2016: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
S Kittel-Schneider, A Reif
The majority of women suffering from psychiatric disorders in pregnancy and the breast feeding prefer psychotherapy and other nonpharmacological treatment over psychopharmacological treatment although the risk of malformations and postnatal complications in children exposed to psychopharmacological drugs must be regarded as acceptable in moderate to severely ill patients. Data are lacking, but several psychotherapeutic and biological treatments as well as noninvasive brain stimulation procedures have been investigated to treat depressive episodes and anxiety disorders in pregnancy and the breast feeding...
September 2016: Der Nervenarzt
Domenico De Berardis
Cariprazine (RGH-188) is a novel antipsychotic drug that exerts partial agonism of dopamine D2/D3 receptors with preferential binding to D3 receptor, antagonism of 5HT2B receptors and partial agonism of 5HT1A. Currently, cariprazine is in late-stage clinical development (phase III clinical trials) in patients with schizophrenia (S) and in patients with bipolar disorder (BD), as well as an adjunctive treatment in patients with Major Depressive Disorder (MDD) and drug-resistant MDD. Cariprazine has completed phase III trials for the acute treatment of schizophrenia and bipolar mania, phase II trials for the bipolar depression and MDD whilst it is undergoing phase III trials as an adjunct to antidepressants...
June 30, 2016: Current Pharmaceutical Design
Soham Rej, Shamira Pira, Victoria Marshe, André Do, Dominique Elie, Karl J Looper, Nathan Herrmann, Daniel J Müller
PURPOSE: Lithium is an essential treatment in bipolar disorder and treatment-resistant depression; however, its use has been limited by concerns regarding its renal adverse effects. An improved understanding of potential molecular mechanisms can help develop prevention and treatment strategies for lithium-associated renal disease. METHODS: We conducted a systematic literature search using MEDLINE, Embase, and PsychINFO including English-language original research articles published prior to November 2015 that specifically investigated lithium's effects on nephrogenic diabetes insipidus (NDI) and chronic kidney disease (CKD), using molecular markers...
June 29, 2016: International Urology and Nephrology
John Muller, Sahana Pentyala, James Dilger, Srinivas Pentyala
Recent evidence has suggested that the N-methyl-D-aspartate receptor antagonist ketamine shows significant therapeutic effects in major depression and bipolar disorder. This effect is especially important in treatment-resistant depression and depression with suicidal ideation. In this review we explain the mechanism of action, drug efficacy, and the side effects of ketamine; the antidepressive effects of ketamine; the individual effects of ketamine isomers, R(-) ketamine and S(+) ketamine; the effects of the combination of ketamine with electroconvulsive therapy; and the possible use of ketamine in treating depression...
June 2016: Therapeutic Advances in Psychopharmacology
Hiroko Sugawara, Kaoru Sakamoto, Tsuyoto Harada, Satoru Shimizu, Jun Ishigooka
BACKGROUND: Several studies have evaluated the efficacy and tolerability of aripiprazole for augmentation of antidepressant therapy for treatment-resistant depression (TRD). Here, we investigated the efficacy of aripiprazole augmentation for TRD including both major depressive disorder and bipolar disorder and the clinical predictors of treatment efficacy in a Japanese population. METHODS: Eighty-five depressed Japanese patients who underwent aripiprazole augmentation therapy after failing to respond satisfactorily to antidepressant monotherapy were included in the study...
2016: Neuropsychiatric Disease and Treatment
Magdalena Chojnacka, Anna Z Antosik-Wójcińska, Monika Dominiak, Dorota Bzinkowska, Agnieszka Borzym, Marlena Sokół-Szawłowska, Gabriela Bodzak-Opolska, Dorota Antoniak, Łukasz Święcicki
BACKGROUND: The aim of the study was to examine the efficacy and safety of morning bright light therapy (BLT) in the treatment of patients with a current major depressive episode (MDE) in bipolar and unipolar disorder without a seasonal pattern. It was a randomized, sham-controlled trial. METHODS: Adults, ages 18-70 years were randomized to treatment either with BLT or a sham negative ion generator (as a placebo control). The subjects were required to be on a stable and therapeutic dose of psychotropic medication for at least 4 weeks prior to enrollment and their treatment had to be insufficiently effective...
October 2016: Journal of Affective Disorders
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