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Severe treatment resistant major depression

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https://www.readbyqxmd.com/read/28187008/guarding-the-gate-remote-structured-assessments-to-enhance-enrollment-precision-in-depression-trials
#1
Marlene P Freeman, James Pooley, Martina J Flynn, Lee Baer, David Mischoulon, David Mou, Maurizio Fava
BACKGROUND: Failed treatment trials are common in major depressive disorder and treatment-resistant depression, and remotely performed multifaceted, centralized structured interviews can potentially enhance signal detection by ensuring that enrolled patients meet eligibility criteria. METHODS: We assessed the use of a specific remote structured interview that validated the diagnosis, level of treatment resistance, and depression severity. The objectives were to (1) assess the rate at which patients who were deemed eligible for participation in trials by site investigators were ineligible, (2) assess the reasons for ineligibility, (3) compare rates of ineligibility between academic and nonacademic sites, (4) compare eligibility between US and non-US sites, and (5) report the placebo response rates in trials utilizing this quality assurance approach, comparing its placebo response rates with those reported in the literature...
February 10, 2017: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28184334/mixed-states-in-bipolar-disorder-etiology-pathogenesis-and-treatment
#2
REVIEW
Ather Muneer
Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term "mixed episode" was dropped and replaced by "mixed features" specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders...
January 2017: Chonnam Medical Journal
https://www.readbyqxmd.com/read/28177952/clinical-factors-related-to-acute-electroconvulsive-therapy-outcome-for-patients-with-major-depressive-disorder
#3
Cheng-Chung Chen, Ching-Hua Lin, Wei-Cheng Yang, Ming-Chao Chen
The aim of this study was to explore the significant predictors associated with electroconvulsive therapy (ECT) outcome for patients with major depressive disorder. Major depressive disorder inpatients (N=130) requiring ECT were recruited from a major psychiatric center in South Taiwan. ECT was generally performed for a maximum of 12 sessions. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S) before ECT, after every three ECT sessions, and after the last ECT...
February 7, 2017: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28162976/neuromodulation-in-response-to-electroconvulsive-therapy-in-schizophrenia-and-major-depression
#4
Philipp Arthur Thomann, Robert Christian Wolf, Henrike Maria Nolte, Dusan Hirjak, Stefan Hofer, Ulrich Seidl, Malte Sebastian Depping, Bram Stieltjes, Klaus Maier-Hein, Fabio Sambataro, Torsten Wüstenberg
BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective treatments in severe and treatment-resistant major depressive disorder (MDD). ECT has been also shown to be effective in schizophrenia (SZ), particularly when rapid symptom reduction is needed or in cases of resistance to drug-treatment. However, its precise mechanisms of action remain largely unknown. OBJECTIVE/HYPOTHESIS: This study examined whether ECT exerts disorder-specific or unspecific modulation of brain structure and function in SZ and MDD...
January 16, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/28138119/the-normalization-of-brain-%C3%A2-%C3%A2-f-fluorodeoxy-d-glucose-positron-emission-tomography-hypometabolism-following-electroconvulsive-therapy-in-a-55-year-old-woman-with-treatment-resistant-late-onset-depression-a-case-report
#5
Jeongjae Bak, Sang Mi Lee, Young-Joon Kwon, Se-Hoon Shim, Joong Il Kim
Major depressive disorder, especially in later life, has heterogeneous clinical characteristics and treatment responses. Symptomatically, psychomotor retardation, lack of energy, and apathy tends to be more common in people with late-onset depression (LOD). Despite recent advances in psychopharmacologic treatments, 20% to 30% of patients with mood disorders experience inadequate responses to medication, often resulting in a trial of electroconvulsive therapy (ECT). However, the therapeutic mechanism of ECT is still unclear...
February 28, 2017: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28098427/emergence-of-mania-in-two-middle-aged-patients-with-a-history-of-unipolar-treatment-refractory-depression-receiving-vagus-nerve-stimulation
#6
Naji C Salloum, Marie C Walker, Sunil Gangwani, Charles R Conway
OBJECTIVES: We report on two patients who experienced emergence of full manic symptoms while receiving vagal nerve stimulation (VNS). METHODS: Two patients, both with a well-documented and verified history of longstanding unipolar depression, were initiated on VNS for treatment of their severe major depressive episodes. RESULTS: The two patients had emergence of full manic symptoms after 8 and 9 months of VNS, respectively. Manic symptoms were adequately managed with standard treatments (mood stabilizer and electroconvulsive therapy) and VNS was continued in the two subjects for up to 5 years without any further occurrences of manic/hypomanic episodes...
January 18, 2017: Bipolar Disorders
https://www.readbyqxmd.com/read/28072660/two-versus-one-high-frequency-repetitive-transcranial-magnetic-stimulation-session-per-day-for-treatment-resistant-depression-a-randomized-sham-controlled-trial
#7
Christos Theleritis, Pavlos Sakkas, Thomas Paparrigopoulos, Silia Vitoratou, Chara Tzavara, Stefania Bonaccorso, Antonios Politis, Constantin R Soldatos, Costantin Psarros
OBJECTIVES: High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear. METHODS: We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatment-resistant major depression with a subsequent 2-week follow-up period...
January 9, 2017: Journal of ECT
https://www.readbyqxmd.com/read/28068461/a-new-prediction-model-for-evaluating-treatment-resistant-depression
#8
Alexander Kautzky, Pia Baldinger-Melich, Georg S Kranz, Thomas Vanicek, Daniel Souery, Stuart Montgomery, Julien Mendlewicz, Joseph Zohar, Alessandro Serretti, Rupert Lanzenberger, Siegfried Kasper
OBJECTIVE: Despite a broad arsenal of antidepressants, about a third of patients suffering from major depressive disorder (MDD) do not respond sufficiently to adequate treatment. Using the data pool of the Group for the Study of Resistant Depression and machine learning, we intended to draw new insights featuring 48 clinical, sociodemographic, and psychosocial predictors for treatment outcome. METHOD: Patients were enrolled starting from January 2000 and diagnosed according to DSM-IV...
January 3, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28049085/high-frequency-repetitive-transcranial-magnetic-stimulation-over-the-left-dlpfc-for-major-depression-session-dependent-efficacy-a-meta-analysis
#9
S Teng, Z Guo, H Peng, G Xing, H Chen, B He, M A McClure, Q Mu
BACKGROUND: Depression is a major debilitating psychiatric disorder. Current antidepressant drugs are often associated with side effects or treatment resistance. The aim of this meta-analysis was to evaluate therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in major depression (MD). METHODS: The medical data bases of PubMed, Medline, Embase and Cochrane Central Register were searched for randomized controlled trials (RCTs) reporting the therapeutic effects of high-frequency rTMS for depression, which were published in English between January 1990 and June 2016...
December 30, 2016: European Psychiatry: the Journal of the Association of European Psychiatrists
https://www.readbyqxmd.com/read/28035869/comparative-efficacy-and-tolerability-of-pharmacological-and-somatic-interventions-in-adult-patients-with-treatment-resistant-depression-a-systematic-review-and-network-meta-analysis
#10
Katerina Papadimitropoulou, Carla Vossen, Andreas Karabis, Christina Donatti, Nicole Kubitz
OBJECTIVE: Major depressive disorder (MDD) affects about 10-15% of the general population in a lifetime. A considerable number of patients fail to achieve full symptom remission despite adequate treatment and are considered treatment resistant (TRD). The current study compared the relative efficacy and tolerability of pharmacological and somatic TRD interventions by means of a Bayesian network meta-analysis. RESEARCH DESIGN AND METHODS: An electronic literature search of MEDLINE, MEDLINE In-Process, EMBASE, PsycInfo, EconLit and Cochrane Library databases for trials published between September 2003 and September 2014 was conducted...
February 6, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27876102/structural-functional-brain-changes-in-depressed-patients-during-and-after-electroconvulsive-therapy
#11
Antoine Yrondi, Patrice Péran, Anne Sauvaget, Laurent Schmitt, Christophe Arbus
OBJECTIVES: Electroconvulsive therapy (ECT) is a non-pharmacological treatment that is effective in treating severe and treatment-resistant depression. Although the efficacy of ECT has been demonstrated to treat major depressive disorder (MDD), the brain mechanisms underlying this process remain unclear. Structural-functional changes occur with the use of ECT as a treatment for depression based on magnetic resonance imaging (MRI). For this reason, we have tried to identify the changes that were identified by MRI to try to clarify some operating mechanisms of ECT...
November 23, 2016: Acta Neuropsychiatrica
https://www.readbyqxmd.com/read/27866918/-children-and-adolescents-anxiety-disorders
#12
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
https://www.readbyqxmd.com/read/27836553/how-much-alcohol-is-in-ketamine-s-antidepressant-action
#13
REVIEW
Udo Bonnet
Ketamine is approved to start and maintain anaesthesia or analgesia. Ketamine is also known to be neurotoxic and an old drug of abuse. Numerous studies have proven a rapid and strong antidepressant response (AR) following parenteral sub-anaesthetic ketamine doses when applied the first time to patients with treatment resistant unipolar or bipolar major depression. This rapid and robust AR is encouraging, though short-lived (usually up to seven days). There is growing evidence that repeated und escalating ketamine administrations exert longer-lasting AR than single infusions...
January 1, 2017: Life Sciences
https://www.readbyqxmd.com/read/27832812/a-longitudinal-cohort-study-of-acute-puerperal-metritis-cases-in-swedish-dairy-cows
#14
Anna Ordell, Helle Ericsson Unnerstad, Ann Nyman, Hans Gustafsson, Renée Båge
BACKGROUND: Acute puerperal metritis affects cows during the early postpartum period and causes fever, fetid vaginal discharge and general depression. The disease is severe and treatment with antimicrobials is often required. This study followed 79 Swedish dairy cows with acute puerperal metritis with registered treatment and outcome in terms of recovery. Bacteria isolated from the uterus and their susceptibility to penicillin were studied. Clinical cases were assigned by participating practitioners who examined the cows, performed uterine swab sampling, decided treatment and provided information about cow health and calving conditions...
November 10, 2016: Acta Veterinaria Scandinavica
https://www.readbyqxmd.com/read/27810712/sleep-architecture-parameters-as-a-putative-biomarker-of-suicidal-ideation-in-treatment-resistant-depression
#15
Rebecca A Bernert, David A Luckenbaugh, Wallace C Duncan, Naomi G Iwata, Elizabeth D Ballard, Carlos A Zarate
BACKGROUND: Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD). METHODS: This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4...
January 15, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/27758708/the-role-of-electroconvulsive-therapy-ect-in-bipolar-disorder-effectiveness-in-522-patients-with-bipolar-depression-mixed-state-mania-and-catatonic-features
#16
Giulio Perugi, Pierpaolo Medda, Cristina Toni, Michela Giorgi Mariani, Chiara Socci, Mauro Mauri
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. <p> 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. <p> Results: Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal...
October 17, 2016: Current Neuropharmacology
https://www.readbyqxmd.com/read/27719778/assessment-and-care-of-childbearing-women-with-severe-and-persistent-mental-illness
#17
REVIEW
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
https://www.readbyqxmd.com/read/27718369/change-in-cytokine-levels-is-not-associated-with-rapid-antidepressant-response-to-ketamine-in-treatment-resistant-depression
#18
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)...
January 2017: Journal of Psychiatric Research
https://www.readbyqxmd.com/read/27698736/use-of-deep-brain-stimulation-for-major-affective-disorders
#19
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
https://www.readbyqxmd.com/read/27672487/a-case-of-treatment-resistant-depression-and-body-dysmorphic-disorder-the-role-of-electroconvulsive-therapy-revisited
#20
Ram S Mahato, Maria Chona P San Gabriel, Carrol T Longshore, David B Schnur
Body dysmorphic disorder is a common, often disabling condition, and is frequently comorbid with major depressive disorder. Selective serotonin reuptake inhibitors constitute first line set of somatic interventions but the management of refractory patients remains challenging. Electroconvulsive therapy, an often highly beneficial treatment for medication resistant-depression, is not considered an effective therapeutic alternative for treatment refractory body dysmorphic disorder. Here we present a 50-year-old woman with body dysmorphic disorder and comorbid major depressive disorder who remained incapacitated and suicidal despite several trials with selective serotonin reuptake inhibitors and antipsychotic medication...
July 2016: Innovations in Clinical Neuroscience
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