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Treatment refractory major depressive disorder

Priyanka Thukral-Mahajan, Nilesh Shah, Gurvinder Kalra, Chittaranjan Andrade
Electroconvulsive therapy (ECT) is considered relatively contraindicated in patients with intracranial space-occupying lesions. A 53-year-old male presented with a 5-year history of medication-refractory major depressive disorder. Brain imaging findings suggested the presence of a ruptured dermoid cyst in the transverse sinus and a calcified meningioma in the temporal lobe sulcal space. There was no evidence of mass effect. Neurofibromatosis was the only other clinical condition present. The patient had no clinical neurological deficits...
October 2017: Indian Journal of Psychiatry
Anne Duffy, Paul Grof
INTRODUCTION: There is a resurgence of interest in lithium treatment of bipolar disorders in part related to its unique anti-suicidal and neuroprotective effects. METHODS: This is a narrative review of key studies pertaining to the effectiveness and tolerability of lithium treatment in pediatric populations. RESULTS: Evidence supports that lithium is an effective and generally well-tolerated acute treatment for pediatric mania compared to placebo...
February 28, 2018: Pharmacopsychiatry
Gin S Malhi, Tim Outhred, Amber Hamilton, Philip M Boyce, Richard Bryant, Paul B Fitzgerald, Bill Lyndon, Roger Mulder, Greg Murray, Richard J Porter, Ajeet B Singh, Kristina Fritz
In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on major depression. It emphasises the importance of shared decision making, tailoring personalised care to the individual, and delivering care in the context of a therapeutic relationship...
March 5, 2018: Medical Journal of Australia
Yuyan Cheng, Sachi Desse, Ana Martinez, Ryan J Worthen, Richard S Jope, Eleonore Beurel
Recovery from major depressive disorder is difficult, particularly in patients who are refractory to antidepressant treatments. To examine factors that regulate recovery, we developed a prolonged learned helplessness depression model in mice. After the induction of learned helplessness, mice were separated into groups that recovered or did not recover within 4 weeks. Comparisons were made between groups in hippocampal proteins, inflammatory cytokines, and blood brain barrier (BBB) permeability. Compared with mice that recovered and control mice, non-recovered mice displaying prolonged learned helplessness had greater hippocampal activation of glycogen synthase kinase-3 (GSK3), higher levels of tumor necrosis factor-α (TNFα), interleukin-17A, and interleukin-23, increased permeability of the blood brain barrier (BBB), and lower levels of the BBB tight junction proteins occludin, ZO1, and claudin-5...
February 13, 2018: Brain, Behavior, and Immunity
Iris van Oostrom, Philip van Eijndhoven, Elke Butterbrod, Maria H van Beek, Joost Janzing, Rogier Donders, Aart Schene, Indira Tendolkar
OBJECTIVE: Electroconvulsive therapy (ECT) is still the most effective treatment of severe and therapy-refractory major depressive disorder. Cognitive side effects are the major disadvantage of ECT. Cognitive deficits are generally temporary in nature and may be mediated by the hippocampus. Recent studies have shown a temporary increase in hippocampal volume and a temporary decrease in cognitive functioning post-ECT compared with pre-ECT. This study investigates whether these volumetric changes are related to changes in cognitive functioning after ECT...
January 31, 2018: Journal of ECT
Ausaf A Bari, Charles B Mikell, Aviva Abosch, Sharona Ben-Haim, Robert J Buchanan, Allen W Burton, Stephen Carcieri, G Rees Cosgrove, Pierre-Francois D'Haese, Zafiris Jeffrey Daskalakis, Emad N Eskandar, Jason L Gerrard, Wayne K Goodman, Benjamin David Greenberg, Robert E Gross, Clement Hamani, Zelma H T Kiss, Peter Konrad, Brian H Kopell, Lothar Krinke, Jean-Philippe Langevin, Andres M Lozano, Donald Malone, Helen S Mayberg, Jonathan P Miller, Parag G Patil, DeLea Peichel, Erika A Petersen, Ali R Rezai, R Mark Richardson, Patricio Riva-Posse, Tejas Sankar, Jason M Schwalb, Helen Blair Simpson, Konstantin Slavin, Paul H Stypulkowski, Tor Tosteson, Peter Warnke, Jon T Willie, Kareem A Zaghloul, Joseph S Neimat, Nader Pouratian, Sameer A Sheth
OBJECTIVE: Refractory psychiatric disease is a major cause of morbidity and mortality worldwide, and there is a great need for new treatments. In the last decade, investigators piloted novel deep brain stimulation (DBS)-based therapies for depression and obsessive-compulsive disorder (OCD). Results from recent pivotal trials of these therapies, however, did not demonstrate the degree of efficacy expected from previous smaller trials. To discuss next steps, neurosurgeons, neurologists, psychiatrists and representatives from industry convened a workshop sponsored by the American Society for Stereotactic and Functional Neurosurgery in Chicago, Illinois, in June of 2016...
January 25, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Alexandra Neyazi, Wiebke Theilmann, Claudia Brandt, Tomi Rantamäki, Nobuaki Matsui, Mathias Rhein, Johannes Kornhuber, Malek Bajbouj, Wolfgang Sperling, Stefan Bleich, Helge Frieling, Wolfgang Löscher
Although electroconvulsive therapy (ECT) is among the most effective treatment options for pharmacoresistant major depressive disorder (MDD), some patients still remain refractory to standard ECT practise. Thus, there is a need for markers reliably predicting ECT non/response. In our study, we have taken a novel translational approach for discovering potential biomarkers for the prediction of ECT response. Our hypothesis was that the promoter methylation of p11, a multifunctional protein involved in both depressive-like states and antidepressant treatment responses, is differently regulated in ECT responders vs...
January 22, 2018: Translational Psychiatry
Morgana Moretti, Camille M Ribeiro, Vivian B Neis, Luis Eduardo B Bettio, Priscila B Rosa, Ana Lúcia S Rodrigues
Considering the involvement of the opioid system in major depressive disorder (MDD), mainly concerning refractory MDD, and the evidence that ascorbic acid may exert a beneficial effect for the treatment of this disorder, this study investigated the involvement of the opioid system in the antidepressant-like effect of ascorbic acid in the tail suspension test (TST). Treatment of Swiss mice with the non-selective opioid receptor antagonist naloxone (1 mg/kg, i.p.) prevented the reduced immobility time caused by ascorbic acid (1 mg/kg, p...
February 2018: Naunyn-Schmiedeberg's Archives of Pharmacology
Chris Baeken, Guo-Rong Wu, Rudi De Raedt
BACKGROUND: Refractory major depressive disorder (MDD) is a severe mental disorder, chronic and difficult to treat. Although generalized anxiety disorder (GAD) is frequently observed as a comorbid diagnosis, little is known on the comorbid neurobiological substrate. Better insights may improve adequate treatment algorithms. OBJECTIVE: To examine this poorly understood clinical question, we recruited 52 individuals to participate in a [18F] FDG PET brain imaging study...
November 14, 2017: Journal of Affective Disorders
Gregory A Ordway, Attila Szebeni, Liza J Hernandez, Jessica D Crawford, Katalin Szebeni, Michelle J Chandley, Katherine C Burgess, Corwin Miller, Erol Bakkalbasi, Russell W Brown
Background: Many patients suffering from depressive disorders are refractory to treatment with currently available antidepressant medications, while many more exhibit only a partial response. These factors drive research to discover new pharmacological approaches to treat depression. Numerous studies demonstrate evidence of inflammation and elevated oxidative stress in major depression. Recently, major depression has been shown to be associated with elevated levels of DNA oxidation in brain cells, accompanied by increased gene expression of the nuclear base excision repair enzyme, poly(ADP-ribose) polymerase-1...
December 1, 2017: International Journal of Neuropsychopharmacology
Marianne Klanker, Matthijs Feenstra, Ingo Willuhn, Damiaan Denys
Deep brain stimulation (DBS) of the medial forebrain bundle (MFB) induces rapid improvement of depressive symptoms in patients suffering from treatment-refractory major depressive disorder (MDD). It has been hypothesized that activation of the dopamine (DA) system contributes to this effect. To investigate whether DBS in the MFB affects DA release in the striatum, we combined DBS with fast-scan cyclic voltammetry (FSCV) in freely moving rats. Animals were implanted with a stimulating electrode at the border of the MFB and the ventral tegmental area, and a FSCV microelectrode in the ventromedial striatum to monitor extracellular DA during the acute onset of DBS and subsequent continued stimulation...
November 19, 2017: Neuroscience
Indira Mendez-David, Céline Boursier, Valérie Domergue, Romain Colle, Bruno Falissard, Emmanuelle Corruble, Alain M Gardier, Jean-Philippe Guilloux, Denis J David
The incorporation of peripheral biomarkers in the treatment of major depressive disorders (MDD) could improve the efficiency of treatments and increase remission rate. Peripheral blood mononuclear cells (PBMCs) represent an attractive biological substrate allowing the identification of a drug response signature. Using a proteomic approach with high-resolution mass spectrometry, the present study aimed to identify a biosignature of antidepressant response (fluoxetine, a Selective Serotonin Reuptake Inhibitor) in PBMCs in a mouse model of anxiety/depression...
2017: Frontiers in Cellular Neuroscience
Kentaro Matsui, Yoshikazu Takaesu, Takeshi Inoue, Ken Inada, Katsuji Nishimura
BACKGROUND: Patients with non-24-hour sleep-wake rhythm disorder (N24SWD) exhibit a sleep pattern that is asynchronous with the external light-dark cycle, typically involving a cycling, relapsing-remitting pattern of sleep disturbances, including nighttime insomnia and daytime sleepiness. Here, we report the case of a patient with N24SWD comorbid with major depressive disorder, who was successfully treated with a low dose of aripiprazole. CASE PRESENTATION: A 47-year-old female presented with an 8-year complaint of difficulty falling asleep and waking up in the morning...
2017: Neuropsychiatric Disease and Treatment
Chittaranjan Andrade
There is a substantial body of literature comprising anecdotal material and descriptions of uncontrolled and randomized controlled trials addressing the use of subanesthetic doses of ketamine for the off-label treatment of major depressive episodes. This article examines diagnostic indications for the off-label use of ketamine as an antidepressant and possible contexts in which ketamine may be trialled. Ketamine is indicated in patients who are in a major depressive episode. Most of the research data have been collected from patients with major depressive disorder, but patients with bipolar depression have also been studied...
May 2017: Journal of Clinical Psychiatry
Mousa Hamad, Ryan Holland, Naveed Kamal, Robert Luceri, Antonios Mammis
INTRODUCTION: Essential tremor (ET) is the most common movement disorder of adults, affecting an estimated 7 million Americans. Symptoms of ET range from slightly noticeable to debilitating, with 1 cohort study finding 15% of patients were forced into early retirement. Additionally, depression has also been correlated with the severity of disability of ET. Treatment options include propranolol and primidone. Current treatment options are not very effective, with more than half (56.3%) of patients discontinuing medications because of no changes in symptoms...
September 2017: World Neurosurgery
Cornel N Stanciu, Oliver M Glass, Thomas M Penders
OBJECTIVE: Current treatment strategies for depressive disorders have limited efficacy, leaving many patients unimproved or with significant residual symptoms. The development of additional treatments represent a significant unmet need for providers. Several lines of evidence suggest that the opioid system may be involved in regulation of mood and incentives salience. Intervention based on modifying central opioid receptors may represent a novel approach to treatment of depressive disorders among those unresponsive to accepted treatments...
April 2017: Asian Journal of Psychiatry
Patric Blomstedt, Matilda Naesström, Owe Bodlund
Deep brain stimulation (DBS) may be considered in severe cases of therapy-refractory major depressive disorder (MDD). However, DBS for MDD is still an experimental therapy. Therefore, it should only be administered in clinical studies driven by multidisciplinary teams, including surgeons with substantial experience of DBS in the treatment of other conditions.
May 2017: Clinical Case Reports
Rebecca J Park, Ilina Singh, Alexandra C Pike, Jacinta O A Tan
Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation (DBS) (3). DBS involves electrode insertion into specific neural targets implicated in pathological behavior, which are then repeatedly stimulated at adjustable frequencies...
2017: Frontiers in Psychiatry
Michael Bauer, Emanuel Severus, Hans-Jürgen Möller, Allan H Young
OBJECTIVE: Major depressive disorder (MDD) is a severe mood disorder affecting individuals of all ages and is characterised by single or recurrent major depressive episodes. Key elements of acute and maintenance treatment of MDD include pharmacotherapy, and psychological approaches such as psychoeducation and adherence monitoring. METHODS: This summary of the 'Practice guidelines for the biological treatment of unipolar depressive disorders' comprises acute, continuation and maintenance treatment developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP), and focuses on pharmacological treatment options...
September 2017: International Journal of Psychiatry in Clinical Practice
Gerardo Maria de Araújo Filho, Bruna Tarifa, Raquel Espagnolla Santos, Ana Laura de Oliveira Dias, Júlia Rodrigues Leandro Ulliano, Lucia Helena Neves Marques
Psychiatric disorders (PD) have an elevated prevalence and an important negative impact on patients with epilepsy (PWE) since they are associated with lower quality of life and clinical refractoriness. However, it is also necessary to identify behavioral conditions possibly associated with epilepsy that are not part of the standard psychiatric classifications, such as Interictal Dysphoric Disorder (IDD) and Interictal Personality (IP). The frequency of IDD and IP in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) was assessed...
April 2017: Epilepsy & Behavior: E&B
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