scholarly journals Predictors of clinical response after rTMS treatment of patients suffering from drug-resistant depression

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aurélie Lacroix ◽  
Benjamin Calvet ◽  
Benjamin Laplace ◽  
Marilyne Lannaud ◽  
Brigitte Plansont ◽  
...  
Keyword(s):  
Clinical Response ◽  
Clinical Improvement ◽  
Depressive Episode ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Routine Practice ◽  
Drug Resistant ◽  
Therapeutic Choice ◽  
Resistant Depression ◽  
Success Of Treatment

AbstractRepeated transcranial magnetic stimulation (rTMS) is a therapeutic brain-stimulation technique that is particularly used for drug-resistant depressive disorders. European recommendations mention the effectiveness of 30 to 64%. The failure rate of treatment is high and clinical improvement is visible only after a certain period of time. It would thus be useful to have indicators that could anticipate the success of treatment and more effectively guide therapeutic choices. We aimed to find predictive indicators of clinical improvement at 1 month after the start of rTMS treatment among the data collected during the care of patients with drug-resistant depression included in the Neuromodulation Unit of the Esquirol Hospital in Limoges since 2007. In total, 290 patients with a pharmaco-resistant depressive episode, according to the Hamilton Depression Rating Scale (HDRS) (score ≥8), before treatment who underwent a complete course of rTMS treatment and did not object to the use of their collected data were included. The clinical response in routine practice, corresponding to a decrease in the HDRS score of at least 50% from inclusion, was determined and complemented by interquartile analysis. A combination of factors predictive of clinical response during care, such as a short duration of the current depressive episode associated with a higher HDRS agitation item value (or a lower perceived sleepiness value) and a higher number of previous rTMS treatments, were identified as being useful in predicting the efficacy of rTMS treatment in routine clinical practice, thus facilitating the therapeutic choice for patients with drug-resistant depression.

scholarly journals Comparative efficacy between ketamine, memantine, riluzole and d-cycloserine in patients diagnosed with drug resistant depression: a meta-analysis

2019 ◽  
Vol 8 (6) ◽  
pp. 1132
Author(s):  
Nishita H. Darji ◽  
Devang A. Rana ◽  
Supriya D. Malhotra
Keyword(s):  
Rating Scale ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Fixed Effect ◽  
P Value ◽  
Drug Resistant ◽  
Effect Model ◽  
Resistant Depression ◽  
Glutamate Modulators

Background: Glutamate modulators are having immense potential and are newer entities for treating drug resistant depression. The objectives were to generate statistical evidence on basis of existing data of ketamine, memantine, riluzole and d-cycloserine in resistant depression.Methods: A total of 14 RCTs following PRISMA guidelines and matching inclusion and exclusion criteria were collected of ketamine (5), memantine (3), riluzole (2) and d-cycloserine (4) vs placebo in drug resistant depression. Only RCTs with primary diagnosis of drug resistant depression (Previously on two standard antidepressant therapy) were included. Studies with treatment response rate, 50% reduction in total score of the depression rating scale-Montgomery-Åsberg Depression Rating Scale or the Hamilton Depression Rating Scale or Beck Depression Inventory was chosen as clinical outcome measure. RevMan 5.3 software was used for the analysis.Results: In ketamine group using random effect model SMD was 2.122 (95% CI 0.659-3.584). P-value was statistically significant (random effect p <0.005 and in fixed effect <0.001). In memantine group, using random effect model -0.963 was SMD and (95% CI -1.958-0.0324). P-value was <0.001, significant in fixed effect. In riluzole group, SMD was -0.564 with (95% CI -3.927-2.799) in random effect. P-value was 0.741. In d-cycloserine group SMD was 0.316 with (95% CI -1.252-1.885) in random effect. P-value was 0.690.Conclusions: Ketamine showed best efficacy followed by memantine. Riluzole and DCS as such have no efficacy although its acts by same glutamate pathway. More molecular based research is required in use of glutamate modulators in resistant depression.

Features of Formation and System of Psychoprophylaxis of Suicidal Behavior in Young Patients with Depression

2017 ◽  
Vol 41 (S1) ◽  
pp. s239-s239
Author(s):  
H. Kozhyna ◽  
V. Mykhaylov ◽  
K. Zelenskay
Keyword(s):  
Family Therapy ◽  
Suicidal Behavior ◽  
Depressive Episode ◽  
Suicide Risk ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Cognitive Behavioral ◽  
Anxiety And Depression

The work covers the study of the formation of suicidal behavior in young adults with depressive disorders and developing of pathogenetic based system of its prevention. There were clinical and psychopathological signs of depressive disorders in young patients analyzed. Anxiety, asthenia, asthenic-apathetic and melancholy variants of depressive disorders in young patients with suicidal behavior were highlighted. In this study, there were the markers of suicide risk for young patients with depressive disorders determined: high suicide risk, low death self-consciousness, high anhedonia level, clinical manifestations of anxiety and depression by the hospital anxiety and depression scale, severe anxiety and depression by the Hamilton anxiety rating scale, major depressive episode by the Montgomery-Asberg depression rating scale. It has been proved that in observed young patients with depressive disorders with suicide behavior increased concentrations of serotonin, cortisol, noradrenaline and decreased levels of adrenaline and melatonine in plasma were observed. These changes were determined as neurohormonal background for depletion of adaptation resource in stress situations. There were approaches to differentiated prevention of suicidal behavior in depressive disorders in young people validated that include pharmacotherapy (selective SSRI, melatonin, serotonin and norepinephrine), psychotherapy and psychoeducation. Psychotherapeutic complexin patients with depressive episode must include personality-oriented psychotherapy, cognitive behavioral therapy, family therapy and autogenous training; in disorders of adaptation – rational psychotherapy, cognitive-behavioral analytic psychotherapy, family therapy, autogenic training. Psychoeducation should be carried out using information modules, training a positive self-image, improved compliance; formation of communication skills, problem solving, interpersonal interaction and problem-oriented discussions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Emotions as a state and as a trait in people with depressive disorders*

2019 ◽  
Vol 73 ◽  
pp. 721-728
Author(s):  
Aleksandra Skiba ◽  
Paulina Maruszewska ◽  
Monika Talarowska ◽  
Piotr Gałecki
Keyword(s):  
Psychosocial Functioning ◽  
Depressive Episode ◽  
Positive Emotions ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Negative Emotions ◽  
Healthy People ◽  
Control Group ◽  
The People ◽  
Positive And Negative Emotions

Depression is a disorder involving a number of changes in human psychosocial functioning. The aim of this study is to evaluate the intensity of positive and negative emotions understood both as a state and a permanent personality trait in people with depressive disorders and to determine whether the intensity of positive and negative emotions differentiates healthy people from people suffering from depressive disorders. The study was conducted on 107 individuals – 67 people from the experimental group suffering from depressive disorders and 40 people from the control group with a negative interview in terms of mental and somatic disorders. The following tools were used: Hamilton Depression Rating Scale (evaluation of severity of depressive symptoms), STAI Questionnaire (evaluation of anxiety severity as a state and trait) and PANAS Questionnaire (intensity of negative and positive emotions as a state and trait). A significantly higher intensity of positive emotions understood both as a state and a trait was observed in the people not suffering from depression, while the opposite results were obtained with regard to negative emotions, i.e. the individuals suffering from depression recorded lower scores than the healthy persons. It was also shown that the people with depression had higher scores in terms of the level of anxiety as a state and trait. The intensity of positive emotions as a state was significantly higher among the people with the first depressive episode in comparison to the people with recurrent depressive disorders. The severity of depression correlated positively with the intensity of negative emotions as a state both at the time of inclusion in the study and after obtaining a response to the applied pharmacological treatment. Experienced positive and negative emotions, understood both as a state and as a trait, differentiate not only individuals with depression from healthy people, but also patients with the first depressive episode and those with recurrent depressive disorders.

Sleep deprivation with sleep phase advance in treatment-resistant depression therapy in relation to features of circadian rhythm and temperament – a pilot study

2019 ◽  
Vol 34 (4) ◽  
pp. 249-262
Author(s):  
Ewa Kurczewska ◽  
Ewa Ferensztajn-Rochowiak ◽  
Maria Chłopocka-Woźniak ◽  
Janusz Rybakowski
Keyword(s):  
Sleep Deprivation ◽  
Clinical Response ◽  
Clinical Improvement ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Sleep Phase ◽  
Affective Temperaments ◽  
Severity Of Depression ◽  
Resistant Depression ◽  
The Relationship

Objectives. The efficacy of pharmacotherapy augmentation by total sleep deprivation (TSD) with sleep phase advance (SPA) was evaluated in patients with treatment-resistant depression (TRD). The study examined the relationship between chronotype, affective temperaments and clinical improvement resulting from the treatment. Material and methods. The study group comprised of 30 persons with treatment-resistant unipolar (n = 15) or bipolar (n = 15) depression aged 52 ± 12 years (17 women and 13 men). TSD and three consecutive nights with SPA were used during pharmacotherapy. Severity of depression was determined using the Hamilton Depression Rating Scale (HDRS). All patients were assessed using the Composite Scale of Morningness (CSM) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A). Results. Clinical response, defined as a reduction in the severity of depression by ≥ 50% in HDRS compared to the baseline score, lasting until the end of the study (14 days), was obtained in 16 out of 30 patients with TRD. There was found no significant correlation between clinical improvement, chronotype and affective temperaments. Conclusions. TSD with SPA proved to be an effective method of pharmacotherapy augmentation in over half of the patients with TRD. The relationship between chronotype, affective temperaments and the clinical response to chronotherapy of depression requires further research.

A Comparative Trial of Two Formulations of Clomipramine

1972 ◽  
Vol 1 (1) ◽  
pp. 30-36 ◽  
Author(s):  
G Beaumont ◽  
J Seldrup
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Clinical Response ◽  
Clinical Improvement ◽  
General Practitioners ◽  
Rating Scale ◽  
Drug Effects ◽  
Comparative Trial ◽  
Good Clinical Response ◽  
Clinical Rating Scale

In a multi-centre clinical trial comparing two formulations of Clomipramine (Anafranil® Geigy) thirty General Practitioners provided two hundred and seven patients. One hundred and forty nine patients completed the study. No difference was found between a capsule and a tablet formulation in terms of tolerance and efficacy. Using a clinical rating scale the total score for twelve symptoms fell from a mean of 18 .2 to 5.5 and 6.0 in the capsule and tablet groups respectively. By recording the presence of symptoms subsequently to be regarded as side effects before admission to the trial many so called drug effects were found to be present before commencing treatment. The forty patients who dropped out of the trial because of intolerable side effects also failed to show any clinical improvement and appeared to constitute a separate group from those who completed the trial and who showed good clinical response in association with a diminishing number of side effects.

scholarly journals Preliminary Pharmacogenetic Study to Explore Putative Dopaminergic Mechanisms of Antidepressant Action

2021 ◽  
Vol 11 (8) ◽  
pp. 731
Author(s):  
Taichi Ochi ◽  
Natalya M. Vyalova ◽  
Innokentiy S. Losenkov ◽  
Diana Z. Paderina ◽  
Ivan V. Pozhidaev ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Sufficient Evidence ◽  
Therapeutic Effects ◽  
Pharmacogenetic Study ◽  
Dopaminergic Mechanisms ◽  
Major Depressive Disorders ◽  
Related Proteins ◽  
Antidepressant Action

Background: There is sufficient evidence that interference of dopaminergic neurotransmission contributes to the therapeutic effects of antidepressants in unipolar and bipolar depression. Methods: Hamilton depression rating scale (HAMD 17) scores of 163 at least moderately ill patients with major depressive disorders were used to establish treatment response. HAMD 17 score status was measured before initiation, after two weeks, and after four weeks of treatment with various antidepressants. The possible association between response and genotype in a total of 14 variants of dopamine neurotransmission-related proteins was investigated. Results: DRD4 rs11246226 CA heterozygous patients were found with a greater improvement of HAMD 17 score when compared to homozygous C patients during 0–2 weeks and 0–4 weeks. Patients with MAOB rs1799836 heterozygous GA and homozygous A also demonstrated improved scores during 2–4 weeks and 0–4 weeks. Conclusions: The results are preliminary due to the limited population size and the small number of variants. Further research into the involvement of habenular dopamine D4 receptors in the antidepressant response is desirable.

scholarly journals Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age

2021 ◽  
Vol 14 (6) ◽  
pp. 582
Author(s):  
Monika Dominiak ◽  
Anna Z. Antosik-Wójcińska ◽  
Marcin Wojnar ◽  
Paweł Mierzejewski
Keyword(s):  
Major Depression ◽  
Autobiographical Memory ◽  
Electroconvulsive Therapy ◽  
Cognitive Functions ◽  
Rating Scale ◽  
Short Form ◽  
Serious Adverse Events ◽  
Before And After ◽  
Trail Making ◽  
Resistant Depression

Electroconvulsive therapy (ECT) remains the most effective therapy in treatment-resistant depression. However, the safety of ECT has been consistently questioned, particularly among elderly patients. We assessed the efficacy and safety of ECT in patients before and after 65 years old. The study was conducted between 2015 and 2018 and included 91 patients (61 under and 29 over 65 years old) with major depression undergoing ECT. The Hamilton Depression Rating Scale was used to evaluate efficacy. Cognitive functions were assessed using: MMSE, RAVLT, Trail Making Test, Stroop Test and Autobiographical Memory Interview-Short Form. ECT was more effective in older patients as compared to younger (p < 0.001). No serious adverse events were observed in either group. Increased blood pressure and arrhythmias were more common in the older compared to the younger group (p = 0.044 and p = 0.047, respectively), while disturbances of consciousness did not differ between groups (p = 0.820). Most of the cognitive functions remained unchanged compared to baseline, whereas the outcomes of MMSE, RAVLT and Stroop tests showed greater improvements in the older compared to the younger group (all p < 0.05). The decline in the retrieval consistency of autobiographical memory was more pronounced in the younger group (p = 0.024). ECT is a highly effective, safe and well-tolerated method of treating depression regardless of age.

Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 738-743 ◽  
Author(s):  
Abilash Haridas ◽  
Michele Tagliati ◽  
Irene Osborn ◽  
Ioannis Isaias ◽  
Yakov Gologorsky ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Functional Disability ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Internal Globus Pallidus ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients &lt;21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

scholarly journals Methylome-wide change associated with response to electroconvulsive therapy in depressed patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lea Sirignano ◽  
Josef Frank ◽  
Laura Kranaster ◽  
Stephanie H. Witt ◽  
Fabian Streit ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Cpg Sites ◽  
Cpg Site ◽  
Depressed Patients ◽  
Resistant Depression ◽  
Functional Pathway ◽  
Regional Analyses ◽  
The Relationship

AbstractElectroconvulsive therapy (ECT) is a quick-acting and powerful antidepressant treatment considered to be effective in treating severe and pharmacotherapy-resistant forms of depression. Recent studies have suggested that epigenetic mechanisms can mediate treatment response and investigations about the relationship between the effects of ECT and DNA methylation have so far largely taken candidate approaches. In the present study, we examined the effects of ECT on the methylome associated with response in depressed patients (n = 34), testing for differentially methylated CpG sites before the first and after the last ECT treatment. We identified one differentially methylated CpG site associated with the effect of ECT response (defined as >50% decrease in Hamilton Depression Rating Scale score, HDRS), TNKS (q < 0.05; p = 7.15 × 10−8). When defining response continuously (ΔHDRS), the top suggestive differentially methylated CpG site was in FKBP5 (p = 3.94 × 10−7). Regional analyses identified two differentially methylated regions on chromosomes 8 (Šídák’s p = 0.0031) and 20 (Šídák’s p = 4.2 × 10−5) associated with ΔHDRS. Functional pathway analysis did not identify any significant pathways. A confirmatory look at candidates previously proposed to be involved in ECT mechanisms found CpG sites associated with response only at the nominally significant level (p < 0.05). Despite the limited sample size, the present study was able to identify epigenetic change associated with ECT response suggesting that this approach, especially when involving larger samples, has the potential to inform the study of mechanisms involved in ECT and severe and treatment-resistant depression.

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