Prevalencia, causas y tratamiento de la depresión mayor

ResumenLa depresión mayor representa un problema de salud pública debido a su alta prevalencia. La etiología de la depresión es compleja, en ella intervienen factores psicosociales, genéticos, y biológicos. Entre los factores psicosociales, se ha observado que los primeros episodios depresivos aparecen después de algún evento estresante, y el estrés que acompaña al primer episodio produce cambios a largo plazo en la fisiología cerebral. Estos cambios de larga duración pueden producir variaciones a nivel estructural y en el funcionamiento de diferentes áreas cerebrales. Entre los factores genéticos que intervienen en la enfermedad depresiva, se ha reportado que alrededor de 200 genes están relacionados con el trastorno depresivo mayor. Dentro de los factores biológicos, existen evidencias de alteraciones a nivel de neurotransmisores, citosinas y hormonas, cuyas acciones inducen modificaciones estructurales y funcionales en el sistema nervioso central, en el sistema inmunológico y en el sistema endocrino, que incrementan el riesgo de padecer la depresión mayor. A pesar de años de estudio, las bases biológicas de la depresión mayor y el mecanismo preciso de la eficacia antidepresiva siguen siendo poco claras. Los objetivos de la presente revisión son el resumir las principales conclusiones de la literatura clínica y experimental en relación con la etiología del trastorno depresivo mayor.Palabras claveDepresión mayor, neurotransmisores, neuroplasticidad, serotonina, norepinefrina, sistema inmune. AbstractMajor depression represents a public health problem due to its high prevalence. The etiology of major depression is complex because involves psychosocial, genetic, and biological factors. Among psychosocial factors, different studies report that the first depressive episode appear after some stressful event and produces long-term changes in brain physiology. These long-lasting changes produce variations at the structural level and in the functioning of different brain areas. Among the genetic factors involved in depressive illness, it has been reported that about 200 genes are related to major depressive disorder. Within the biological factors, there is an evidence of alterations in the level of neurotransmitters, cytosine’s and hormones, whose actions induces structural and functional modifications in the central nervous system, the immune system and the endocrine system, which increases the risk of suffering major depression. Despite years of study, the biological basis of major depression and precise mechanisms of antidepressant efficacy remain unclear. The objective of the present review is to summarize the main conclusions of the clinical and experimental literature regarding to the etiology of major depressive disorder.Key wordsMajor depression, neurotransmitters, neuroplasticity, serotonin, norepinephrine, immune system.

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Immune Mechanisms of Depression

10.1093/med/9780190681425.003.0028 ◽

2017 ◽

Author(s):

Caroline Ménard ◽

Madeline L. Pfau ◽

Georgia E. Hodes ◽

Scott J. Russo

Keyword(s):

Immune System ◽

Lupus Erythematosus ◽

Clinical Findings ◽

Behavioral Symptoms ◽

Biological Factors ◽

Major Depressive ◽

The Past ◽

Inflammatory Conditions ◽

Stress Models ◽

Pro Inflammatory Cytokines

Mood disorders such as major depressive disorder (MDD) are diagnosed largely based upon behavioral symptoms rather than biological factors. Some have argued that a lack of rigorous biomarker-based diagnosis is the reason why 30%–50% of MDD patients are unresponsive to traditional antidepressant medications. Over the past few decades, MDD has been shown to be highly prevalent in patients suffering from chronic inflammatory conditions, such as lupus erythematosus, multiple sclerosis, etc. Moreover, subgroups of MDD patients have shown consistently higher levels of circulating pro-inflammatory cytokines. Together, these clinical findings suggest that alterations within the immune system might contribute to the behavioral symptoms of MDD. In this chapter, we review the growing literature in both humans with MDD and in rodent stress models of depression that support a role for the immune system in depression.

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A model for the evaluation of spirituality and resilience in major depressive disorder

Psihiatru ro ◽

10.26416/psih.58.3.2019.2532 ◽

2019 ◽

Vol 3 (1) ◽

pp. 40-44

Author(s):

Emilia-Cristina Popescu ◽

Doina Cozman

Keyword(s):

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Suicide Risk ◽

Depression Scale ◽

Public Health Problem ◽

Control Group ◽

Major Depressive ◽

Psychiatric Interview ◽

Area Of Interest

Depression is an important public health problem at the moment. There are data that can influence the spiritual spirit and resilience on major depression, can be studied imposingly and to cope with a Romanian population. The study will evaluate the spirituality, resilience, symptoms and severity of depression and suicide risk on a sample of adult patients diagnosed with major depression. The control group will consist of participants without psychiatric background, comparable as age and sex with the first group. Patients will undergo a structured psychiatric interview (M.I.N.I. – International Neuropsychiatric Interview), will complete a demographic questionnaire and will assessed with a depression scale, suicide risk scale, resilience and spirituality scale. Spirituality and religiosity become an area of interest for the study of depression protective factors. The present paper may propose to demonstrate the beneficial influence of the spirituality on the symptoms of major depression and the reduction of suicide risk in major depressive disorder. If the study will find a statistically significant correlation between spirituality and suicide risk reduction, it will emphasize the importance of spirituality in the evolution of psychiatric patients and it may change their approach and management.

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Socio-demographic and Clinical Characteristics of Patient with Thyroid Cancer

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v11i1.45668 ◽

2020 ◽

Vol 11 (1) ◽

pp. 54-58

Author(s):

AKM Farhad Hossain ◽

Md Mahmudur Rahman Siddiqui ◽

Sayada Fatema Khatun

Keyword(s):

Public Health ◽

Thyroid Cancer ◽

Clinical Characteristics ◽

Family Income ◽

Ethical Issues ◽

Endocrine System ◽

Public Health Problem ◽

Follicular Carcinoma ◽

Public Health Issue ◽

Cross Sectional

Background: Thyroid cancer is the most common malignant disease in endocrine system. It is an emerging public health issue associated with burden on the family, community and the nation. The aim of this study is to determine the socio-demographic and clinical characteristics of patient with thyroid cancer attending in tertiary hospital. Methods: This cross sectional study was conducted among 246 thyroid cancer patients in two tertiary hospitals of Dhaka city from 01 July 2018 to 30 June 2019. The subjects were selected purposively following specific selection criteria and maintaining ethical issues. Data were collected by face to face interview using a semi-structured questionnaire and checklist. Data were analyzed by the statistical package for the social science (SPSS) version 23. Results: This study revealed that majority (74.4%) of respondents was female, married (72%), housewife (61.4%), rural respondent (41.1%) and had primary education (69%). Mean (± SD) age of the respondent was 37.85(±12.20) years (Range 14-70 years) and mean (± SD) monthly family income was Tk. 17681(±10602). Out of 246 cases, 204 (82.9%) was papillary and 42 (17.1%) was follicular carcinoma. Various clinical presentations included visible neck swelling in 225 (91.5%), swollen lymph node in 103 (41.9%), pain 90 (36.6%), Difficulties in swallowing 87 (35.4%), Hoarseness of voice in 141 (57.3%), cough along with swelling 47(19.1%), Difficulties in breathing due to swelling in 13(5.3%) of the patients. Conclusion: Incidence of thyroid cancer has increased worldwide specially in female patients in 3rd and 4th decades of life. As thyroid cancer is a growing public health problem in Bangladesh, proper screening and early diagnostic facilities at all level should be available to measure its actual burden in the country. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 54-58

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The Relationships between HIV-1 Infection, History of Methamphetamine Use Disorder, and Soluble Biomarkers in Blood and Cerebrospinal Fluid

Viruses ◽

10.3390/v13071287 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1287

Author(s):

T. Walter ◽

Jennifer Iudicello ◽

Debra Cookson ◽

Donald Franklin ◽

Bin Tang ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Immune System ◽

Public Health Problem ◽

Control Group ◽

Csf Biomarkers ◽

Immune System Dysfunction ◽

Immune Biomarkers ◽

Plasma Factor ◽

History Of ◽

Hiv 1

Methamphetamine (METH) use disorder is highly prevalent among people with HIV (PWH) and is a significant public health problem. HIV and METH use are each associated with immune system dysfunction; however, the combined effects on the immune system are poorly understood. This cross-sectional project measured soluble immune biomarkers in plasma and cerebrospinal fluid (CSF) collected from a control group, people with a history of a METH use disorder (METH+), PWH with no history of METH use disorder (HIV+), and PWH with a history of METH use disorder (HIV+/METH+). HIV, METH, and immune dysfunction can also be associated with affective and cognitive deficits, so we characterized mood and cognition in our participants. Two factor analyses were performed for the plasma and CSF biomarkers. Plasma IL-8, Ccl2, VEGF, and 8-isoprostane loaded onto one factor that was highest in the HIV+/METH+ group (p < 0.047) reflecting worse inflammation, vascular injury, and oxidative stress. This plasma factor was also negatively correlated with delayed recall (R = −0.49, p = 0.010), which was worst in the HIV+/METH+ group (p = 0.030 compared to the control group). Overall, these data implicate that combined HIV-1 infection and METH use may exacerbate inflammation, leading to worse cognition.

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The Symptom Structure of Postdisaster Major Depression: Convergence of Evidence from 11 Disaster Studies Using Consistent Methods

Behavioral Sciences ◽

10.3390/bs11010008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 8

Author(s):

Carol S. North ◽

David Baron

Keyword(s):

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Diagnostic Assessment ◽

Self Report ◽

Depression Symptoms ◽

Symptom Scale ◽

Major Depressive ◽

Report Symptom ◽

Symptom Patterns

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior self-report symptom-scale studies. The sample included 808 directly-exposed survivors of 10 disasters assessed 1–6 months post disaster and 373 employees of 8 organizations affected by the September 11, 2001 terrorist attacks assessed nearly 3 years after the attacks. Consistent symptom patterns identifying postdisaster major depression were not found across the 2 databases, and database factor analyses suggested a cohesive grouping of depression symptoms. In conclusion, this study did not find symptom clusters identifying postdisaster major depression to guide the construction and validation of screeners for this disorder. A full diagnostic assessment for identification of postdisaster major depressive disorder remains necessary.

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Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867421998796 ◽

2021 ◽

pp. 000486742199879

Author(s):

Pavitra Aran ◽

Andrew J Lewis ◽

Stuart J Watson ◽

Thinh Nguyen ◽

Megan Galbally

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Symptoms ◽

Major Depression ◽

Depressive Disorder ◽

Emotional Availability ◽

Major Depressive ◽

Interaction Quality ◽

Pregnancy Cohort ◽

The Impact

Objective: Poorer mother–infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder ( n = 60) and bipolar disorder ( n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant’s interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring’s emotional availability at 6 months postpartum, particularly in maternal intrusiveness.

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Glucocorticoid Signaling in Stress-Related Psychiatric Disorders Uncovered by Dexamethasone-Induced Gene Expression

10.14293/s2199-1006.1.sor-uncat.eitgtn.v2 ◽

2017 ◽

Author(s):

Andreas Menke

Keyword(s):

Gene Expression ◽

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Glucocorticoid Receptor ◽

Psychiatric Disorders ◽

Hpa Axis ◽

Stimulation Test ◽

Major Depressive ◽

Depressed Patients

Major depressive disorder (MDD) is a common, serious and in some cases life‐threatening condition and affects approximately 350 million people globally (Otte et al., 2016). The magnitude of the clinical burden reflects the limited effectiveness of current available therapies. The current prescribed antidepressants are based on modulating monoaminergic neurotransmission, i.e. they improve central availability of serotonin, norepinephrine and dopamine. However, they are associated with a high rate of partial or non-response, delayed response onset and limited duration. Actually more than 50% of the patients fail to respond to their first antidepressant they receive. Therefore there is a need of new treatment approaches targeting other systems than the monoaminergic pathway. One of the most robust findings in biological psychiatry is a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in major depression (Holsboer, 2000). Many studies observed an increased production of the corticotropin-releasing hormone (CRH) in the hypothalamus, leading to an increased release of adrenocorticotropic hormone (ACTH) from the pituitary and subsequently to an enhanced production of cortisol in the adrenal cortex. Due to an impaired sensitivity of the glucocorticoid receptor (GR) the negative feedback mechanisms usually restoring homeostasis after a stress triggered cortisol release are not functioning properly (Holsboer, 2000, Pariante and Miller, 2001). However, treatment strategies targeting the GR or the CRH receptors have not been successful for a general patient population. Selecting the right patients for these treatment alternatives may improve therapy outcome, since a dysregulation of the HPA axis affects only 40-60 % of the depressed patients. Thus, patients with a dysregulated HPA axis have first to be identified and then allocated to a specific treatment regime. Tests like the dexamethasone-suppression-test (DST) or the dex-CRH test have been shown to uncover GR sensitivity deficits, but are not routinely applied in the clinical setting. Recently, the dexamethasone-induced gene expression could uncover GR alterations in participants suffering from major depression and job-related exhaustion (Menke et al., 2012, Menke et al., 2013, Menke et al., 2014, Menke et al., 2016). Actually, by applying the dexamethasone-stimulation test we found a GR hyposensitivity in depressed patients (Menke et al., 2012) and a GR hypersensitivity in subjects with job-related exhaustion (Menke et al., 2014). These alterations normalized after clinical recovery (Menke et al., 2014). Interestingly, the dexamethasone-stimulation test also uncovered FKBP5 genotype dependent alterations in FKBP5 mRNA expression in depressed patients and healthy controls (Menke et al., 2013). FKBP5 is a co-chaperone which modulates the sensitivity of the GR (Binder, 2009). In addition, the dexamethasone-stimulation test provided evidence of common genetic variants that modulate the immediate transcriptional response to GR activation in peripheral human blood cells and increase the risk for depression and co-heritable psychiatric disorders (Arloth et al., 2015). In conclusion, the molecular dexamethasone-stimulation test may thus help to characterize subgroups of subjects suffering from stress-related conditions and in the long-run may be helpful to guide treatment regime as well as prevention strategies. References: Arloth J, Bogdan R, Weber P, Frishman G, Menke A, Wagner KV, Balsevich G, Schmidt MV, Karbalai N, Czamara D, Altmann A, Trumbach D, Wurst W, Mehta D, Uhr M, Klengel T, Erhardt A, Carey CE, Conley ED, Major Depressive Disorder Working Group of the Psychiatric Genomics C, Ruepp A, Muller-Myhsok B, Hariri AR, Binder EB, Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium PGC (2015) Genetic Differences in the Immediate Transcriptome Response to Stress Predict Risk-Related Brain Function and Psychiatric Disorders. Neuron 86:1189-1202. Binder EB (2009) The role of FKBP5, a co-chaperone of the glucocorticoid receptor in the pathogenesis and therapy of affective and anxiety disorders. Psychoneuroendocrinology 34 Suppl 1:S186-195. Holsboer F (2000) The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology 23:477-501. Menke A, Arloth J, Best J, Namendorf C, Gerlach T, Czamara D, Lucae S, Dunlop BW, Crowe TM, Garlow SJ, Nemeroff CB, Ritchie JC, Craighead WE, Mayberg HS, Rex-Haffner M, Binder EB, Uhr M (2016) Time-dependent effects of dexamethasone plasma concentrations on glucocorticoid receptor challenge tests. Psychoneuroendocrinology 69:161-171. Menke A, Arloth J, Gerber M, Rex-Haffner M, Uhr M, Holsboer F, Binder EB, Holsboer-Trachsler E, Beck J (2014) Dexamethasone stimulated gene expression in peripheral blood indicates glucocorticoid-receptor hypersensitivity in job-related exhaustion. Psychoneuroendocrinology 44:35-46. Menke A, Arloth J, Putz B, Weber P, Klengel T, Mehta D, Gonik M, Rex-Haffner M, Rubel J, Uhr M, Lucae S, Deussing JM, Muller-Myhsok B, Holsboer F, Binder EB (2012) Dexamethasone Stimulated Gene Expression in Peripheral Blood is a Sensitive Marker for Glucocorticoid Receptor Resistance in Depressed Patients. Neuropsychopharmacology 37:1455-1464. Menke A, Klengel T, Rubel J, Bruckl T, Pfister H, Lucae S, Uhr M, Holsboer F, Binder EB (2013) Genetic variation in FKBP5 associated with the extent of stress hormone dysregulation in major depression. Genes Brain Behav 12:289-296. Otte C, Gold SM, Penninx BW, Pariante CM, Etkin A, Fava M, Mohr DC, Schatzberg AF (2016) Major depressive disorder. Nature reviews Disease primers 2:16065. Pariante CM, Miller AH (2001) Glucocorticoid receptors in major depression: relevance to pathophysiology and treatment. Biological psychiatry 49:391-404.

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Lifetime Comorbidity of Panic Attacks and Major Depression in a Population-Based Study

The British Journal of Psychiatry ◽

10.1192/bjp.165.3.363 ◽

1994 ◽

Vol 165 (3) ◽

pp. 363-369 ◽

Cited By ~ 43

Author(s):

Laura Andrade ◽

William W. Eaton ◽

Howard Chilcoat

Keyword(s):

Mental Health ◽

Major Depression ◽

Catchment Area ◽

Population Based ◽

Panic Attacks ◽

Major Depressive ◽

Population Based Study ◽

Comorbid Disorder ◽

Motor Disturbance ◽

Symptom Profiles

BackgroundThe co-occurrence of panic disorder and major depression in the same individual is common. A question to be answered is whether the comorbid disorder is a distinct one or may resemble one or other disorder. In this paper we examine whether the comorbid disorder is a distinct condition.MethodWe examined the symptom profiles and rates of comorbidity of panic attacks and DIS/DSM–III major depressive disorder in a population-based sample from four sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (n= 12 668).ResultsThe co-occurrence of panic attacks and major depression over the lifetime was 11 times higher than expected by chance (OR = 11.4, 95% CI 9.5 to 13.6). Subjects with both panic and depression had worse symptoms than those who had only one disorder. However, the pattern of symptoms was remarkably similar, after overall severity was taken into account. Depressive symptoms associated with more severe forms of depression (e.g. guilt, suicidal thoughts or attempts, and motor disturbance) were more frequent in the comorbid group.ConclusionsThese findings may indicate a worse severity when the two disorders occur in the same individual.

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The Antibody Response to Plasmodium falciparum: Cues for Vaccine Design and the Discovery of Receptor-Based Antibodies

Annual Review of Immunology ◽

10.1146/annurev-immunol-042617-053301 ◽

2019 ◽

Vol 37 (1) ◽

pp. 225-246 ◽

Cited By ~ 9

Author(s):

Joshua Tan ◽

Luca Piccoli ◽

Antonio Lanzavecchia

Keyword(s):

Public Health ◽

Plasmodium Falciparum ◽

Immune System ◽

Antibody Response ◽

Public Health Problem ◽

Vaccine Design ◽

Immunoglobulin Genes ◽

And Control ◽

Sterilizing Immunity

Plasmodium falciparum remains a serious public health problem and a continuous challenge for the immune system due to the complexity and diversity of the pathogen. Recent advances from several laboratories in the characterization of the antibody response to the parasite have led to the identification of critical targets for protection and revealed a new mechanism of diversification based on the insertion of host receptors into immunoglobulin genes, leading to the production of receptor-based antibodies. These advances have opened new possibilities for vaccine design and passive antibody therapies to provide sterilizing immunity and control blood-stage parasites.

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Increasing Anticipatory Pleasure in Major Depression through Enhancing Episodic Future Thinking: A Randomized Single-Case Series Trial

10.31234/osf.io/9uy42 ◽

2019 ◽

Author(s):

David John Hallford ◽

Manoj Kumar Sharma ◽

David W. Austin

Keyword(s):

Major Depressive Disorder ◽

Major Depression ◽

Mental Imagery ◽

Single Case ◽

Case Series ◽

Episodic Future Thinking ◽

Future Thinking ◽

Major Depressive ◽

Positive Events ◽

Series Design

Depressed individuals have difficulty anticipating pleasure, which can impact motivation and functioning. One factor in this may be impairments in their episodic future thinking (EFT). This study examined whether enhancing EFT through increasing detail/vividness and mental imagery would increase anticipatory pleasure among individuals with Major Depressive Disorder. A randomized start-point, single case series design was used. Depressed outpatients (N = 7) completed surveys through the day over two weeks to nominate upcoming positive events and rate them on EFT detail/vividness, mental imagery, and anticipatory pleasure. At a randomized start-point, activities to enhance the detail/vividness and mental imagery for these upcoming events were introduced. Significant increases in detail and imagery were observed when EFT activities were introduced, which correlated with increases in how pleasurable it was thought the activities would be and how pleasurable it was thinking about them. Enhancing EFT may be a mechanism to increase anticipatory pleasure in depression. Implications for treatment are discussed.

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