scholarly journals Alertness in patients with treatment-resistant depression: interface between sleep medicine and psychiatry—review article

2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Dusan Kolar ◽  
Michael V. Kolar
Keyword(s):  
Daytime Sleepiness ◽  
Work Performance ◽  
Main Body ◽  
Treatment Resistant Depression ◽  
Quality Of Sleep ◽  
Treatment Resistant ◽  
Residual Symptoms ◽  
Stimulant Medications ◽  
Resistant Depression

Abstract Background Treatment-resistant depression (TRD) is a significant problem in clinical practice and reason for the lack of functional recovery among depressed patients. Sleep disturbances and poor alertness are common residual symptoms. Main body of the abstract Many patients with refractory depression experience residual symptoms, such as insomnia, daytime sleepiness, and poor alertness. This is a literature review and we searched the electronic databases, including PubMed, the Cochrane database, Ovid MEDLINE, PsycINFO, and Google Scholar of all studies published between 2000 and 2020. The literature on the relationship between sleep quality and alertness in a patient with depression is very sparse. One possible reason could be the difficulty in defining alertness as a mental function. Alertness itself has been described as a state of responsivity to both interoceptive and external stimuli. Subjective and objective measures of alertness, daytime somnolence, and quality of sleep are presented. Adjunctive treatment with stimulant medications (methylphenidate, amphetamine, modafinil) to the standard antidepressant medications might be warranted in patients in patients with daytime sleepiness, decreased alertness, fatigue, and poor work performance. Short conclusion Patients with treatment-resistant depression usually suffer from poor quality of sleep and decreased alertness. Stimulant medications may help with alertness, daily functioning, and work performance.

scholarly journals Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

2020 ◽  
Vol 23 (9) ◽  
pp. 587-625 ◽  
Author(s):  
Rachael W Taylor ◽  
Lindsey Marwood ◽  
Emanuella Oprea ◽  
Valeria DeAngel ◽  
Sarah Mather ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Evidence Based ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Comprehensive Overview ◽  
Objective Evidence ◽  
Resistant Depression ◽  
Evidence Based Care ◽  
Guidelines For Depression

Abstract Background Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. Methods A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. Results Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. Conclusions This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.

scholarly journals Long-Term Impact of Residual Symptoms in Treatment-Resistant Depression

2011 ◽  
Vol 56 (9) ◽  
pp. 549-557 ◽  
Author(s):  
Abebaw Fekadu ◽  
Sarah C Wooderson ◽  
Lena J Rane ◽  
Kalypso Markopoulou ◽  
Lucia Poon ◽  
...  
Keyword(s):  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Residual Symptoms ◽  
Resistant Depression ◽  
Long Term Impact

Magnetic seizure therapy in treatment-resistant depression: clinical, neuropsychological and metabolic effects

2014 ◽  
Vol 45 (5) ◽  
pp. 1073-1092 ◽  
Author(s):  
S. Kayser ◽  
B. H. Bewernick ◽  
A. Matusch ◽  
R. Hurlemann ◽  
M. Soehle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Fdg Pet ◽  
Metabolic Effects ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Magnetic Seizure Therapy ◽  
Resistant Depression ◽  
Pet Scans

Background.Magnetic seizure therapy (MST), despite being in an early phase of clinical research, has been demonstrated to be associated with antidepressant efficacy. However, safety, tolerability and efficacy data in connection with functional brain activity from larger samples are lacking. The aim of this study was to determine clinical and cognitive effects of MST and the influence of MST on regional brain glucose metabolism.Method.Twenty-six patients suffering from treatment-resistant depression (TRD) underwent MST. Ten patients underwent a randomized trial and 16 patients an open-label study design. The primary outcome criterion was the severity of depressive symptoms assessed with the Hamilton Depression Rating Scale (HAMD). Depressive symptoms, tolerability and cognitive safety, along with social functioning and quality of life parameters, were assessed using various rating scales. A clinical follow-up visit 6 months following the completion of a course of MST and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) scans of 12 patients were analysed.Results.A significant response to MST was demonstrated by 69% of the patient sample, with 46% meeting remission criteria. Anxiety ratings were significantly reduced in responders and their quality of life was improved. Half of the responders relapsed within 6 months. No cognitive side-effects were observed. FDG-PET scans showed a metabolic increase in the frontal cortex bilaterally and a decrease in the left striatum.Conclusions.Robust antidepressant and anti-anxiety efficacy of MST was demonstrated, and found to be associated with localized metabolic changes in brain areas that are strongly implicated in depression. Thus, MST presents an effective, well-tolerated and safe treatment option for patients unable to respond to other forms of therapy for depression.

scholarly journals Antianhedonic Effect of Repeated Ketamine Infusions in Patients With Treatment Resistant Depression

2021 ◽  
Vol 12 ◽  
Author(s):  
Alina Wilkowska ◽  
Mariusz Stanisław Wiglusz ◽  
Maria Gałuszko-Wegielnik ◽  
Adam Włodarczyk ◽  
Wiesław Jerzy Cubała
Keyword(s):  
Depressive Symptoms ◽  
Depressive Episode ◽  
Controlled Trial ◽  
Self Report ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Antidepressive Effect ◽  
Resistant Depression ◽  
Depression Symptomatology

Anhedonia constitutes one of the main symptoms of depressive episode. It correlates with suicidality and significantly effects the quality of patient's lives. Available treatments are not sufficient against this group of symptoms. Ketamine is a novel, rapid acting strategy for treatment resistant depression. Here we report the change in symptoms of anhedonia measured by Snaith-Hamilton Pleasure Scale as an effect of eight ketamine infusions as an add-on treatment in 42 patients with treatment resistant depression. We also determined the effect of this change on the severity of depressive symptoms measured by Inventory for Depression Symptomatology-Self Report 30-Item (IDS-SR 30). We have observed statistically significant decrease in the level of anhedonia during ketamine treatment. After adjusting for potential confounders we have found that significant reduction in Snaith-Hamilton Pleasure Scale (SHAPS) after each infusion and 1 week post treatment was observed only among patients who did not use benzodiazepines. The reduction in symptoms of anhedonia mediates the antidepressive effect of ketamine. The results need replication in a larger randomized placebo controlled trial.

scholarly journals 119 Assessment of Health-Related Quality of Life and Health Status in Patients with Treatment-resistant Depression

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 277-278
Author(s):  
Carol Jamieson ◽  
Vanina Popova ◽  
Ella Daly ◽  
Kimberly Cooper ◽  
Madhukar H. Trivedi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Related Quality ◽  
Health Related ◽  
Resistant Depression ◽  
Anxiety Depression ◽  
Eq Vas

Abstract:Objective:To assess health-related quality of life (HRQoL) and health status of patients with treatment resistant depression (TRD), treated with esketamine nasal spray+oral antidepressant (ESK+AD) vs oral antidepressant+placebo nasal spray (AD+PBO) using European Quality of Life Group-5-Dimension-5-Level (EQ-5D-5L). The EQ-5D-5L descriptive system consists of five domains relevant for patients with depression (mobility, self-care, usual activities, pain, anxiety/depression) and the EQ-Visual Analogue Scale (EQ-VAS).Methods:Data from TRANSFORM-2 (NCT02418585), a randomized, double-blind short-term study were analyzed. Patients (18-64 years inclusive) with TRD were included. Patient reported health status change using EQ-5D-5L and EQ-VAS was measured from baseline to end of 4-week induction phase (endpoint). Each domain of EQ-5D-5L included 5 levels of perceived problems (L1: no problems; L5: extreme problems).Results:Full analysis set included 223 patients (ESK+AD: 114; AD+PBO: 109). At endpoint, mean (SD) change in health status index was 0.288 (0.2317) for ESK+AD group and 0.231 (0.2506) for AD+PBO group with higher score reflecting higher levels of functioning. At endpoint, percentage of patients reporting problems (grouped L2-L5 responses for each dimension) in ESK+AD vs AD+PBO group: mobility (13.5% vs 25.7%), self-care (16.2% vs 30.5%), usual activities (55.0% vs 71.4%), pain (38.7% vs 52.4%), and anxiety/depression (71.2% vs 78.1%). Mean (SD) change in EQ-VAS score at endpoint was 29.1 (26.32) for ESK+AD and 20.9 (26.60) for AD+PBO group.Conclusion:Greater improvement in HRQoL and health status using EQ-5D-5L and EQ-VAS was observed among patients with TRD treated with ESK+AD vs AD+PBO.Funding Acknowledgements:This study was sponsored by Janssen Research and Development, LLC.

scholarly journals PMH52 IMPROVEMENT IN QUALITY-OF-LIFE WITH RISPERIDONE AUGMENTATION IN TREATMENT-RESISTANT DEPRESSION

2004 ◽  
Vol 7 (3) ◽  
pp. 279
Author(s):  
D Walling ◽  
M Rupnow ◽  
C Canuso ◽  
G Gharabawi ◽  
I Turkoz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

The burden of treatment-resistant depression: A systematic review of the economic and quality of life literature

2019 ◽  
Vol 242 ◽  
pp. 195-210 ◽  
Author(s):  
Karissa M. Johnston ◽  
Lauren C. Powell ◽  
Ian M. Anderson ◽  
Shelagh Szabo ◽  
Stephanie Cline
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Burden Of Treatment ◽  
Resistant Depression
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