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Adolescent resistant depression

Jeffrey R Strawn, Eric T Dobson, Lisa L Giles
The evidence base for psychopharmacologic interventions in youth with depressive and anxiety disorders as well as attention/deficit hyperactivity disorder (ADHD) has dramatically increased over the past two decades. Psychopharmacologic interventions commonly utilized in the pediatric primary care setting-selective serotonin (norepinephrine) reuptake inhibitors (SSRIs/SSNRIs), stimulants and α2 agonists-are reviewed. General pharmacologic principles are summarized along with class-related side effects and tolerability concerns (e...
December 30, 2016: Current Problems in Pediatric and Adolescent Health Care
Kimberly R Urban, Rita J Valentino
Stress is implicated in psychiatric illnesses that are characterized by impairments in cognitive functions that are mediated by the medial prefrontal cortex (mPFC). Because sex and age determine stress vulnerability, the effects of repeated social stress occurring during early adolescence, mid-adolescence, or adulthood on the cellular properties of male and female rat mPFC Layer V neurons in vitro were examined. Repeated resident-intruder stress produced age- and sex-specific effects on mPFC intrinsic and synaptic excitability...
December 23, 2016: Cerebral Cortex
G Munch, N Godart
INTRODUCTION: Adolescence is a unique phase of the human developmental process. In adolescents, psychotropic medications may have different efficacy and tolerance profiles compared to those at other stages of the lifespan. Mood stabilizers are a complex pharmacological category including lithium, some anticonvulsants, and some second generation antipsychotics. Focusing on this class of pharmacological agents, we aim to answer the following questions: in which indications and according to which modalities should mood stabilizers be prescribed during adolescence? METHODS: Information was sought from the websites of the French Haute Autorité de santé (HAS) and Agence nationale de sécurité du médicament et des produits de santé (ANSM), the American Food and Drug Administration (FDA) and the British National Institute for Health and Clinical Excellence (NICE)...
November 18, 2016: L'Encéphale
H Denis, A Baghdadli
Anxiety disorders were long underestimated in children by healthcare professionals, but they are now better diagnosed. They account for the most frequent psychiatric diagnosis between 6 and 18 years of age, with differences in prevalence or risk factors related to the clinical forms. Different clinical subtypes of anxiety disorders are detailed in this article: separation anxiety, specific phobia, generalized anxiety, social anxiety, panic disorder, post-traumatic stress syndrome, and obsessional-compulsive disorder...
January 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Annette M La Greca, Jill Ehrenreich-May, Laura Mufson, Sherilynn Chan
BACKGROUND: Social anxiety disorder (SAD) and depression are common among adolescents, frequently comorbid, and resistant to change. Prevention programs for adolescent SAD are scant, and depression prevention programs do not fully address peer-risk factors. One critical peer-risk factor for SAD and depression is peer victimization. We describe the development and initial evaluation of a transdiagnostic school-based preventive intervention for adolescents with elevated symptoms of social anxiety and/or depression and elevated peer victimization...
December 2016: Child & Youth Care Forum
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
Kathryn R Cullen, Suzanne Jasberg, Brent Nelson, Bonnie Klimes-Dougan, Kelvin O Lim, Paul E Croarkin
OBJECTIVE: Deep transcranial magnetic stimulation (TMS) with an H-1 coil was recently approved by the U.S. Food and Drug Administration (U.S. FDA) for treatment-resistant depression (TRD) in adults. Studies assessing the safety and effectiveness of deep TMS in adolescent TRD are lacking. The purpose of this brief report is to provide a case history of an adolescent enrolled in an investigational deep TMS protocol. METHODS: A case history is described of the first participant of a sham-controlled clinical trial who had a seizure in the course of deep TMS with parameter settings extrapolated from the adult studies that led to US FDA approval (H-1 coil, 120% target stimulation intensity, 18 Hz, 55 trains of 2-second duration, total 1980 pulses)...
September 2016: Journal of Child and Adolescent Psychopharmacology
Giuseppe Talani, Francesca Biggio, Valentina Licheri, Valentina Locci, Giovanni Biggio, Enrico Sanna
Early-life exposure to stress, by impacting on a brain still under development, is considered a critical factor for the increased vulnerability to psychiatric disorders and abuse of psychotropic substances during adulthood. As previously reported, rearing C57BL/6J weanling mice in social isolation (SI) from their peers for several weeks, a model of prolonged stress, is associated with a decreased plasma and brain levels of neuroactive steroids such as 3α,5α-THP, with a parallel up-regulation of extrasynaptic GABAA receptors (GABAAR) in dentate gyrus (DG) granule cells compared to group-housed (GH) mice...
2016: Frontiers in Cellular Neuroscience
Lauren B Shomaker, Nichole R Kelly, Courtney K Pickworth, Omni L Cassidy, Rachel M Radin, Lisa M Shank, Anna Vannucci, Katherine A Thompson, Sara A Armaiz-Flores, Sheila M Brady, Andrew P Demidowich, Ovidiu A Galescu, Amber B Courville, Cara Olsen, Kong Y Chen, Eric Stice, Marian Tanofsky-Kraff, Jack A Yanovski
BACKGROUND: Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset. PURPOSE: We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk. METHOD: We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ≥16) and T2D family history...
October 2016: Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine
Andrea Cipriani, Xinyu Zhou, Cinzia Del Giovane, Sarah E Hetrick, Bin Qin, Craig Whittington, David Coghill, Yuqing Zhang, Philip Hazell, Stefan Leucht, Pim Cuijpers, Juncai Pu, David Cohen, Arun V Ravindran, Yiyun Liu, Kurt D Michael, Lining Yang, Lanxiang Liu, Peng Xie
BACKGROUND: Major depressive disorder is one of the most common mental disorders in children and adolescents. However, whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. Consequently, we aimed to compare and rank antidepressants and placebo for major depressive disorder in young people. METHODS: We did a network meta-analysis to identify both direct and indirect evidence from relevant trials...
August 27, 2016: Lancet
Lucinda A Poole, Andrew J Lewis, John W Toumbourou, Tess Knight, Melanie D Bertino, Reima Pryor
Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self-harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual-level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi-family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD)...
May 9, 2016: Family Process
Tabatha H Melton, Paul E Croarkin, Jeffrey R Strawn, Shawn M McClintock
BACKGROUND: A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited. OBJECTIVE: The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents...
March 2016: Journal of Psychiatric Practice
V T Ramaekers, J M Sequeira, E V Quadros
Multiple factors such as genetic and extraneous causes (drugs, toxins, adverse psychological events) contribute to neuro-psychiatric conditions. In a subgroup of these disorders, systemic folate deficiency has been associated with macrocytic anemia and neuropsychiatric phenotypes. In some of these, despite normal systemic levels, folate transport to the brain is impaired in the so-called cerebral folate deficiency (CFD) syndromes presenting as developmental and psychiatric disorders. These include infantile-onset CFD syndrome, infantile autism with or without neurologic deficits, a spastic-ataxic syndrome and intractable epilepsy in young children expanding to refractory schizophrenia in adolescents, and finally treatment-resistant major depression in adults...
July 2016: Biochimie
John L Shannonhouse, Dustin W DuBois, Annette S Fincher, Alejandra M Vela, Morgan M Henry, Paul J Wellman, Gerald D Frye, Caurnel Morgan
Initial antidepressant treatment can paradoxically worsen symptoms in depressed adolescents by undetermined mechanisms. Interestingly, antidepressants modulate GABAA receptors, which mediate paradoxical effects of other therapeutic drugs, particularly in females. Although the neuroanatomic site of action for this paradox is unknown, elevated GABAA receptor signaling in the nucleus accumbens can disrupt motivation. We assessed fluoxetine's effects on motivated behaviors in pubescent female hamsters - anhedonia in the reward investigational preference (RIP) test as well as anxiety in the anxiety-related feeding/exploration conflict (AFEC) test...
August 1, 2016: Progress in Neuro-psychopharmacology & Biological Psychiatry
Xiao-Ru Yang, Lisa Marie Langevin, Natalia Jaworska, Adam Kirton, R Marc Lebel, Ashley D Harris, Yamile Jasaui, T Christopher Wilkes, Mariko Sembo, Rose Swansburg, Frank P MacMaster
AIM: Structural, functional, and metabolic changes in the dorsolateral prefrontal cortex (DLPFC) are implicated in the pathogenesis of major depressive disorder (MDD). We used proton magnetic resonance spectroscopy ((1) H-MRS) to examine the metabolite choline (glycerophosphocholine plus phosphocholine), which is used as an index of membrane integrity in the left DLPFC, in adolescents and young adults with MDD who were treatment-resistant and had a positive family history compared to healthy controls...
July 2016: Psychiatry and Clinical Neurosciences
Wei Huang, Andon N Placzek, Gonzalo Viana Di Prisco, Sanjeev Khatiwada, Carmela Sidrauski, Krešimir Krnjević, Peter Walter, John A Dani, Mauro Costa-Mattioli
Adolescents are especially prone to drug addiction, but the underlying biological basis of their increased vulnerability remains unknown. We reveal that translational control by phosphorylation of the translation initiation factor eIF2α (p-eIF2α) accounts for adolescent hypersensitivity to cocaine. In adolescent (but not adult) mice, a low dose of cocaine reduced p-eIF2α in the ventral tegmental area (VTA), potentiated synaptic inputs to VTA dopaminergic neurons, and induced drug-reinforced behavior. Like adolescents, adult mice with reduced p-eIF2α-mediated translational control were more susceptible to cocaine-induced synaptic potentiation and behavior...
March 1, 2016: ELife
Douglas G Kondo, Lauren N Forrest, Xianfeng Shi, Young-Hoon Sung, Tracy L Hellem, Rebekah S Huber, Perry F Renshaw
Major depressive disorder (MDD) often begins during adolescence and is projected to become the leading cause of global disease burden by the year 2030. Yet, approximately 40 % of depressed adolescents fail to respond to standard antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI). Converging evidence suggests that depression is related to brain mitochondrial dysfunction. Our previous studies of MDD in adult and adolescent females suggest that augmentation of SSRI pharmacotherapy with creatine monohydrate (CM) may improve MDD outcomes...
August 2016: Amino Acids
Stephanie H Cook, Justin E Heinze, Alison L Miller, Marc A Zimmerman
PURPOSE: Forming secure friendship attachments during adolescence are important for mental health; few, however, have specifically examined the ways in which the transitions in attachment during adolescence may influence future mental health outcomes among African Americans. METHODS: The present study examines how transitions in attachment in adolescence predicted changes in depression symptoms from late adolescents through adulthood in an African-American sample...
March 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Young-Ming Hsiao, Tsung-Chih Tsai, Yu-Ting Lin, Chien-Chung Chen, Chiung-Chun Huang, Kuei-Sen Hsu
Stressful experiences during early life (ELS) can affect brain development, thereby exerting a profound and long-lasting influence on mental development and psychological health. The stress inoculation hypothesis presupposes that individuals who have early experienced an attenuated form of stressors may gain immunity to its more virulent forms later in life. Increasing evidence demonstrates that ELS may promote the development of subsequent stress resistance, but the mechanisms underlying such adaptive changes are not fully understood...
May 2016: Psychoneuroendocrinology
Christopher A Wall, Paul E Croarkin, Mandie J Maroney-Smith, Laura M Haugen, Joshua M Baruth, Mark A Frye, Shirlene M Sampson, John D Port
OBJECTIVE: Preliminary studies suggest that repetitive transcranial magnetic stimulation (rTMS) may be an effective and tolerable intervention for adolescents with treatment-resistant depression. There is limited rationale to inform coil placement for rTMS dosing in this population. We sought to examine and compare three localization techniques for coil placement in the context of an open-label trial of high-frequency rTMS for adolescents with treatment-resistant depression. METHODS: Ten adolescents with treatment-resistant depression were enrolled in an open-label trial of high-frequency rTMS...
September 2016: Journal of Child and Adolescent Psychopharmacology
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