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Severe treatment resistant major 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
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
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
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
Cynthia S Kubu, Tim Brelje, Meryl A Butters, Thilo Deckersbach, Paul Malloy, Paul Moberg, Alexander I Tröster, Eric Williamson, Gordon H Baltuch, Mahendra T Bhati, Linda L Carpenter, Darin D Dougherty, Robert H Howland, Ali R Rezai, Donald A Malone
BACKGROUND: We report the neuropsychological outcome of 25 patients with treatment-resistant major depressive disorder (TRD) who participated in an Institutional Review Board (IRB)-approved randomised double-blind trial comparing active to sham deep brain stimulation (DBS) in the anterior limb of the ventral capsule/ventral striatum (VC/VS). METHODS: Participants were randomised to active (n=12) versus sham (n=13) DBS for 16 weeks. Data were analysed at the individual and group levels...
September 22, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
D M Rotroff, D G Corum, A Motsinger-Reif, O Fiehn, N Bottrel, W C Drevets, J Singh, G Salvadore, R Kaddurah-Daouk
Ketamine, at sub-anesthetic doses, is reported to rapidly decrease depression symptoms in patients with treatment-resistant major depressive disorder (MDD). Many patients do not respond to currently available antidepressants, (for example, serotonin reuptake inhibitors), making ketamine and its enantiomer, esketamine, potentially attractive options for treatment-resistant MDD. Although mechanisms by which ketamine/esketamine may produce antidepressant effects have been hypothesized on the basis of preclinical data, the neurobiological correlates of the rapid therapeutic response observed in patients receiving treatment have not been established...
2016: Translational Psychiatry
Christian Otte, Stefan M Gold, Brenda W Penninx, Carmine M Pariante, Amit Etkin, Maurizio Fava, David C Mohr, Alan F Schatzberg
Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD...
2016: Nature Reviews. Disease Primers
B Romeo, W Choucha, P Fossati, J-Y Rotge
OBJECTIVE: The aim of this review was to determine the clinical and biological predictors of the ketamine response. METHODS: A systematic research on PubMed and PsycINFO database was performed without limits on year of publication. RESULTS: The main predictive factors of ketamine response, which were found in different studies, were (i) a family history of alcohol dependence, (ii) unipolar depressive disorder, and (iii) neurocognitive impairments, especially a slower processing speed...
September 9, 2016: L'Encéphale
Tia Sternat, Martin A Katzman
Anhedonia, defined as the state of reduced ability to experience feelings of pleasure, is one of the hallmarks of depression. Hedonic tone is the trait underlying one's characteristic ability to feel pleasure. Low hedonic tone represents a reduced capacity to experience pleasure, thus increasing the likelihood of experiencing anhedonia. Low hedonic tone has been associated with several psychopathologies, including major depressive disorder (MDD), substance use, and attention-deficit hyperactivity disorder (ADHD)...
2016: Neuropsychiatric Disease and Treatment
Hanna Leinola, Kirsi Honkalampi, Tuomo Hänninen, Heli Koivumaa-Honkanen, Soili M Lehto, Anu Ruusunen, Heimo Viinamäki, Minna Valkonen-Korhonen
OBJECTIVE: A proportion of patients with major depressive disorder (MDD) show cognitive impairment that is associated with treatment nonresponse and poorer functional recovery. A broader range of cognitive dysfunction has been found to be associated with treatment-resistant depression (TRD) and with the presence of psychotic symptoms. Thus far, the effects of psychotic symptoms on the neuropsychological profile of patients with treatment-resistant MDD have not been investigated. METHOD: In the present study, 44 treatment-resistant MDD patients with (n = 12) or without (n = 32) psychotic symptoms-based on the Structured Clinical Interview (SCID I)-were compared with regard to their clinical status and performance in a neuropsychological test battery...
September 6, 2016: Archives of Clinical Neuropsychology: the Official Journal of the National Academy of Neuropsychologists
P van Eijndhoven, P Mulders, L Kwekkeboom, I van Oostrom, M van Beek, J Janzing, A Schene, I Tendolkar
Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from severe or treatment-resistant major depressive disorder (MDD). Unfortunately its underlying neurobiological mechanisms are still unclear. One line of evidence indicates that the seizures produced by ECT induce or stimulate neuroplasticity effects. Although these seizures also affect the cortex, the effect of ECT on cortical thickness is not investigated until now. We acquired structural magnetic resonance imaging data in 19 treatment-resistant MDD patients before and after a bilateral ECT course, and 16 healthy controls at 2 time points, and compared changes in cortical thickness between the groups...
2016: Translational Psychiatry
Matilda Naesström, Patric Blomstedt, Owe Bodlund
Deep brain stimulation for psychiatric disorders Deep brain stimulation is an established treatment for movement disorders. It has been proven to be a safe method; only minor complications have been reported in larger studies. New indications for deep brain stimulation are under investigation; among them major depressive disorder and obsessive-compulsive disorder. Deep brain stimulation for severe and therapy-resistant major depressive disorder and obsessive compulsive-disorder shows promising results. However, the experience of deep brain stimulation in psychiatric disorders is limited...
2016: Läkartidningen
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
Racheli Magnezi, Emanuel Aminov, Dikla Shmuel, Merav Dreifuss, Pinhas Dannon
OBJECTIVES: Major depressive disorder (MDD) is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD) is generally defined as a failure to achieve remission, despite therapeutic interventions. AIM: The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS)...
2016: Patient Preference and Adherence
Kevin M Swiatek, Kim Jordan, Julie Coffman
Treatment-resistant depression (TRD) is a disabling disorder that can interfere with a patient's capacity to understand and participate in medical care and thus negatively impact individual morbidity and mortality. Hospitalised patients with TRD may require rapid alleviation of severe symptomatology, particularly when suicidal or if unable to participate in care decisions. Ketamine is well known for its anaesthetic effects and its use as a 'street' drug; however, its action as an N-methyl-D-aspartate receptor antagonist makes ketamine a potential therapy for TRD...
2016: BMJ Case Reports
Kristi Pettai, Lili Milani, Anu Tammiste, Urmo Võsa, Raivo Kolde, Triin Eller, David Nutt, Andres Metspalu, Eduard Maron
The reasons for variability in treatment response in major depressive disorder (MDD) are not fully understood, but there is accumulating evidence suggesting that therapeutic outcomes of antidepressants can be influenced by genetic factors. In the present study we applied the microarray Illumina platform for whole genome expression profiling in depressive patients treated with escitalopram medication in order to identify genes underlying response to antidepressant treatment. The initial study sample consisted of 135 outpatients with major depressive disorder (mean age 31...
September 2016: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
David Kovacs, Peter Kovacs, Nora Eszlari, Xenia Gonda, Gabriella Juhasz
Immunotherapies revolutionised the treatment of several disorders but show specific side-effect profiles which frequently involve psychological symptoms. Long term interferon-alpha (IFN-alpha) therapy can cause wide-ranging psychiatric side-effects from fatigue, insomnia, anxiety to full-blown depression. This treatment-emergent depression shares several symptoms with major depressive disorder (MDD) with a predominance of somatic/neurovegetative symptoms, and can be treated with antidepressants. However, this experience directed research to inflammatory mechanisms in MDD...
August 2016: Current Opinion in Pharmacology
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
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