Potential Mechanisms and Clinical Effectiveness of Acupuncture in Depression

: Major depressive disorder is the most common mental disorder with a significant economic burden and limited treatments. Acupuncture has emerged as a promising non-pharmacological treatment for reducing depressive symptoms. However, the potential mechanisms and clinical effectiveness of acupuncture are not fully understood. The aim of this review was to: (1) summarize the available evidence on the mechanisms and clinical effectiveness of acupuncture for depression, and then (2) compare with pharmacological interventions, guiding future studies. Studies with animal models of depression and patients have shown that acupuncture could increase hippocampal and network neuroplasticity and decrease brain inflammation, and so has the potential to alleviate depressive disorders. Overall clinical studies indicated that acupuncture could relieve primary depression, particularly milder cases, and was helpful in the management of post-stroke depression, pain-related depression, and postpartum depression both as an isolated and adjunct treatment. It was emphasized that acupuncture combined with antidepressant pharmacological treatment not only enhanced the improvement of primary and secondary depressive symptoms but also reduced the side effects of the medical treatment-the main cause for high dropout rates with drug treatment. In summary, substantial evidence from animal and human researches supported the beneficial effect of acupuncture in depression. However, most clinical trials of acupuncture were small, and it is unclear whether their findings can be generalized; thus, more studies are needed.

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Dietary Patterns: A New Therapeutic Approach for Depression?

Current Pharmaceutical Biotechnology ◽

10.2174/1389201019666180925122116 ◽

2019 ◽

Vol 20 (2) ◽

pp. 123-129 ◽

Cited By ~ 3

Author(s):

Mariana Jesus ◽

Tânia Silva ◽

César Cagigal ◽

Vera Martins ◽

Carla Silva

Keyword(s):

Depressive Symptoms ◽

Dietary Patterns ◽

Large Scale ◽

Randomized Clinical Trials ◽

Dietary Intervention ◽

Common Mental Disorder ◽

Controlled Trial ◽

Statistical Significance ◽

Inverse Association ◽

The Impact

Introduction: The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact. Method: A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included. Results: We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results. Discussion: he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms. Conclusion: More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

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Trial by Triad: substituted judgment, mental illness and the right to die

Journal of Medical Ethics ◽

10.1136/medethics-2020-107154 ◽

2021 ◽

pp. medethics-2020-107154

Author(s):

Jacob M Appel

Keyword(s):

Depressive Symptoms ◽

Depressive Disorders ◽

Substituted Judgment ◽

Diminished Capacity ◽

Accepted Standard ◽

The Usa ◽

Aid In Dying ◽

Incapacitated Patients ◽

The Right

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life (PMP/LQL) as a result of their depressive symptoms when similarly situated incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death.

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Toll-like receptor 4-mediated cytokine synthesis and post-stroke depressive symptoms

Translational Psychiatry ◽

10.1038/s41398-021-01359-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Michal Korostynski ◽

Dzesika Hoinkis ◽

Marcin Piechota ◽

Slawomir Golda ◽

Joanna Pera ◽

...

Keyword(s):

Gene Expression ◽

Depressive Symptoms ◽

Ex Vivo ◽

Toll Like Receptor ◽

Toll Like Receptor 4 ◽

Post Stroke ◽

Cytokines And Chemokines ◽

Patient Health ◽

Post Stroke Depression ◽

Cytokine Synthesis

AbstractAltered cytokine synthesis thought to contribute to the pathophysiology of post-stroke depression (PSD). Toll-like receptor 4 (TLR4) is a master regulator of innate immunity. The aim of this study was to explore the putative association between TLR4-mediated cytokine synthesis and subsequent symptoms of PSD. In total, 262 patients with ischemic stroke and without a history of PSD were included. Depressive symptoms were assessed using the Patient Health Questionnaire-9 in 170 patients on Day 8 and in 146 at 3 months after stroke. Blood samples taken on Day 3 after stroke were stimulated ex vivo with lipopolysaccharide (LPS). Ex vivo synthesized cytokines (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12p70) and circulating cytokines (TNFα, IL-6, sIL-6R, and IL-1ra) were measured using the enzyme-linked immunoassay or cytometric method. RNA sequencing was used to determine the gene expression profile of LPS-induced cytokines and chemokines. LPS-induced cytokine synthesis and the gene expression of TLR4-dependent cytokines and chemokines did not differ between patients with and without greater depressive symptoms. The plasma level of IL-6, but not TNFα, sIL-6R, and IL-1ra, was higher in patients who developed depressive symptoms at 3 months after stroke (median: 4.7 vs 3.4 pg/mL, P = 0.06). Plasma IL-6 predicted the severity of depressive symptoms at 3 months after stroke (β = 0.42, P = 0.03). In conclusion, TLR4-dependent cytokine synthesis was not associated with greater post-stroke depressive symptoms in this study. Circulating IL-6 might be associated with depressive symptoms occurring at 3 months after stroke.

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Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13041070 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1070

Author(s):

Maike Wolters ◽

Annkathrin von der Haar ◽

Ann-Kristin Baalmann ◽

Maike Wellbrock ◽

Thomas L. Heise ◽

...

Keyword(s):

Depressive Symptoms ◽

Treatment Duration ◽

Depressive Disorders ◽

Meta Analysis ◽

Pufa Supplementation ◽

Depressive Symptomology ◽

Beneficial Effects ◽

Randomized Controlled ◽

Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

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Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people

BMJ Open ◽

10.1136/bmjopen-2020-040061 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040061

Author(s):

Getinet Ayano ◽

Asmare Belete ◽

Bereket Duko ◽

Light Tsegay ◽

Berihun Assefa Dachew

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Depressive Disorders ◽

Meta Analysis ◽

Random Effect ◽

Homeless People ◽

Sensitivity Analyses ◽

Prevalence Rates ◽

Major Depressive ◽

Major Depressive Disorders

ObjectivesTo assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people.DesignSystematic review and meta-analysis.Data sourcesDatabases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people.Eligibility criteriaOriginal epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people.Data extraction and synthesisA random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute’s quality assessment checklist was used to measure the study quality. Cochran’s Q and the I2 test were used to assess heterogeneity between the studies.ResultsForty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25–50 years).ConclusionThis review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.

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Systematic review: Symptoms of parental depression and anxiety and offspring overweight

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054001731 ◽

2020 ◽

Vol 54 ◽

pp. 49

Author(s):

Paula Lobo Marco ◽

Inaê Dutra Valério ◽

Christian Loret de Mola Zanatti ◽

Helen Gonçalves

Keyword(s):

Depressive Symptoms ◽

Childhood Obesity ◽

Mental Disorder ◽

Common Mental Disorder ◽

Positive Association ◽

Depression And Anxiety ◽

Recurrent Depression ◽

Child Feeding ◽

Middle Income ◽

Symptoms Of Depression

OBJECTIVE: To evaluate the existing literature on the association between parents’ depression and anxiety and their influence on their children’s weight during childhood, identifying possible mechanisms involved in this association. METHODS: A systematic search of the literature was conducted in the PubMed, PsycINFO and SciELO databases, using the following descriptors: (maternal OR mother* OR parent* OR paternal OR father) AND (“common mental disorder” OR “mental health” OR “mental disorder” OR “depressive disorder” OR depress* OR anxiety OR “anxiety disorder”) AND (child* OR pediatric OR offspring) AND (overweight OR obes* OR “body mass index” OR BMI). A total of 1,187 articles were found after peer selection. RESULTS: In total, 16 articles that met the inclusion criteria were selected for the review. Most of them investigated depressive symptoms and only three, symptoms of maternal anxiety. The evaluated studies suggested a positive association between symptoms of maternal depression and higher risk of childhood obesity. The results diverged according to the chronicity of depressive symptoms (episodic or recurrent depression) and income of the investigated country (high or middle income). Mechanisms were identified passing by quality of parenthood, affecting behaviors related to physical activity and child-feeding, as mediators of the association. CONCLUSIONS: We conclude there is evidence of a positive relationship between the occurrence of maternal symptoms of depression and anxiety and childhood obesity. It is emphasized the need for a better understanding on the effect of depressive symptoms and the contextual factors involved in this relationship so that effective intervention strategies can be implemented.

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Elevated Brain Fatty Acid Amide Hydrolase Induces Depressive-Like Phenotypes in Rodent Models: A Review

International Journal of Molecular Sciences ◽

10.3390/ijms22031047 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1047

Author(s):

Dorsa Rafiei ◽

Nathan J. Kolla

Keyword(s):

Depressive Symptoms ◽

Fatty Acid ◽

Animal Models ◽

Fatty Acid Amide Hydrolase ◽

Acid Amide ◽

Endocannabinoid System ◽

Animal Models Of Depression ◽

Amide Hydrolase ◽

Fatty Acid Amide

Altered activity of fatty acid amide hydrolase (FAAH), an enzyme of the endocannabinoid system, has been implicated in several neuropsychiatric disorders, including major depressive disorder (MDD). It is speculated that increased brain FAAH expression is correlated with increased depressive symptoms. The aim of this scoping review was to establish the role of FAAH expression in animal models of depression to determine the translational potential of targeting FAAH in clinical studies. A literature search employing multiple databases was performed; all original articles that assessed FAAH expression in animal models of depression were considered. Of the 216 articles that were screened for eligibility, 24 articles met inclusion criteria and were included in this review. Three key findings emerged: (1) FAAH expression is significantly increased in depressive-like phenotypes; (2) genetic knockout or pharmacological inhibition of FAAH effectively reduces depressive-like behavior, with a dose-dependent effect; and (3) differences in FAAH expression in depressive-like phenotypes were largely localized to animal prefrontal cortex, hippocampus and striatum. We conclude, based on the animal literature, that a positive relationship can be established between brain FAAH level and expression of depressive symptoms. In summary, we suggest that FAAH is a tractable target for developing novel pharmacotherapies for MDD.

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SOP: treatment of delirium

Neurological Research and Practice ◽

10.1186/s42466-021-00110-7 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Juraj Kukolja ◽

Jens Kuhn

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Pharmacological Treatment ◽

Heart Surgery ◽

Standard Operating Procedure ◽

Risk Behaviour ◽

Severe Trauma ◽

Pharmacological Interventions ◽

Hospitalised Patients ◽

High Risk Behaviour

Abstract Introduction Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium. Comments In order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour. Conclusion The SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.

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Progesterone after Estradiol Modulates Shuttle-Cage Escape by Facilitating Volition

Journal of Experimental Neuroscience ◽

10.4137/jen.s32735 ◽

2015 ◽

Vol 9s1 ◽

pp. JEN.S32735

Author(s):

Darryl J. Mayeaux ◽

Sarah M. Tandle ◽

Sean M. Cilano ◽

Matthew J. Fitzharris

Keyword(s):

Depressive Symptoms ◽

Animal Models ◽

Electric Shock ◽

Ovarian Hormones ◽

Learning Task ◽

The Other ◽

Female Rats ◽

Animal Models Of Depression ◽

Escape Learning

In animal models of depression, depression is defined as performance on a learning task. That task is typically escaping a mild electric shock in a shuttle cage by moving from one side of the cage to the other. Ovarian hormones influence learning in other kinds of tasks, and these hormones are associated with depressive symptoms in humans. The role of these hormones in shuttle-cage escape learning, however, is less clear. This study manipulated estradiol and progesterone in ovariectomized female rats to examine their performance in shuttle-cage escape learning without intentionally inducing a depressive-like state. Progesterone, not estradiol, within four hours of testing affected latencies to escape. The improvement produced by progesterone was in the decision to act, not in the speed of learning or speed of escaping. This parallels depression in humans in that depressed people are slower in volition, in their decisions to take action.

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Clinical profiles relating gender and depressive symptoms among adolescents ascertained by the Beck Depression Inventory II

European Psychiatry ◽

10.1016/s0924-9338(02)00663-6 ◽

2002 ◽

Vol 17 (4) ◽

pp. 222-226 ◽

Cited By ~ 74

Author(s):

R. Coelho ◽

A. Martins ◽

H. Barros

Keyword(s):

Depressive Symptoms ◽

Beck Depression Inventory ◽

Sleep Disturbances ◽

Depressive Disorders ◽

Demographic Variables ◽

High Rate ◽

Discriminative Power ◽

Portuguese Version ◽

Co Morbidity ◽

Social Demographic

SummaryPurposeDepressive disorders (DD) in adolescence are often misdiagnosed and under-recognised. A major clinical problem regards the high rate of co-morbidity with other disorders, namely substance abuse. The aim of this study was to assess the discriminative power of the Beck Depression Inventory II (BDI-II) to characterise specific social–demographic variables related to DD in adolescence.MethodsA Portuguese version of the BDI-II and a social–demographic questionnaire were administered to 775 Portuguese adolescents (312 males, 463 females; mean age: 16.9 years); 83 adolescents performed a clinical interview following DSM-IV criteria.ResultsMean BDI-II Portuguese version (BDI-II-P) total score was 10.31 (standard deviation: 8.4), with females reporting more depressive symptoms than males (P < 0.001). Low academic achievement, sleep disturbances, and alcohol consumption were consistently associated with depressive symptoms for both genders. Higher tobacco consumption was significantly associated with depressive symptoms in females. Familial factors did not appear to be associated with depressive symptoms in males. However, a higher frequency of siblings, having separated parents as well as a more extreme perception of the mother's educational style were consistently associated with depressive symptoms in females.ConclusionThe BDI-II-P showed discriminative power to characterise social–demographic variables related to DD especially in adolescent females.

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