Effects of neurofeedback on major depressive disorder: a systematic review

ABSTRACT Background Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated. Objective We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies. Methods We searched for experimental studies published between 1962-2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria. Results We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results. Conclusion Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Trastorno de depresión mayor e intento suicida en una paciente pediátrica víctima de abuso sexual / Major depressive disorder and suicidal attempt in a pediatric patient victim of sexual abuse

RESUMEN Introducción: el abuso sexual en la infancia se define como una experiencia traumática que puede llevar a la víctima a padecer complicaciones mentales, sexuales, físicas, interpersonales y comportamentales, nefastas para la salud. Además, constituye un factor de riesgo que desencadena el trastorno depresivo mayor en mujeres. Presentación del caso: se trata de una paciente femenina de 17 años de edad que sufrió abuso sexual a los siete años de edad. La paciente ingresa en una primera ocasión el 5 marzo de 2018 por intento suicida y trastorno depresivo al tener contacto con la persona que efectuó el acto. Pasados 17 días la paciente vuelve a ser ingresada por presentar un cuadro de trastorno depresivo mayor y egresa nueve días después por buena evolución. El 7 de agosto ingresa por tercera vez por trastorno depresivo mayor e intento suicida nuevamente. La paciente fue tratada con Imipramina de 25 mg dos veces al día y con tratamiento psicoterapéutico, al cual respondió adecuadamente. La paciente se encuentra psicológicamente estable. Conclusiones: el abuso sexual en la niñez constituye un factor de riesgo desencadenante del trastorno depresivo mayor. La atención especial mediante apoyo y estudios psicológicos de los pacientes, y el tratamiento de fármacos antidepresivos es de vital importancia para la recuperación de víctimas sometidas a acoso sexual con ideación e intento suicidas.

ABSTRACT Introduction: childhood sexual abuse is defined as a traumatic experience that can lead the victim to suffer mental, sexual, physical, interpersonal and behavioral complications harmful to health. It is also a risk factor for major depressive disorder in women. With this case, the authors aim to share experiences to the diagnosis; treatment and prevention of these health problems by disseminating them to the medical community. Case report: a 17-year-old female patient who was sexually abused at the age of 7 years. The patient is admitted on a first occasion on March 5, 2018 for suicide attempt and depressive disorder upon contact with the person who performed the act. After 17 days, the patient was admitted again for major depressive disorder and was discharged 9 days later due to good evolution. On August 7, she was admitted for a third time for major depressive disorder and another suicide attempt. The patient was treated with Imipramine 25 mg twice a day and psychotherapeutic treatment, responding satisfactorily. The patient is psychologically stable at present. Conclusions: sexual abuse in childhood constitutes a risk factor triggering major depressive disorder. Special attention through support and psychological studies of the patients and treatment with antidepressant drugs is of vital importance for the recovery of victims subjected to sexual harassment with suicidal ideation and attempt.

Major depressive episode in hospital workers during the Covid-19 pandemic in Brazil

ABSTRACT OBJECTIVES To estimate prevalence and factors associated with major depressive episode (MDE), emphasizing occupational aspects, in workers of a public teaching hospital that is a reference for Covid-19 treatment. METHODS A cross-sectional study was carried out between October and December 2020, after the first peak of the pandemic, interviewing 1,155 workers. The prevalence of MDE was estimated using the Patient Health Questionnaire (PHQ-9) algorithm. Multivariate hierarchical analysis was conducted using Poisson regression to assess associated factors. RESULTS MDE prevalence was 15.3% (95%CI: 13.3-17.5) and was higher among young, white and female workers, those with a family history of depression, resident professionals, nursing professionals, workers who were exposed to three or more situations of moral dilemma, and those who had to put off a physiological need until later. Having a risk factor for Covid-19, being a smoker and being physically inactive were also positively associated with MDE. CONCLUSIONS The study points to the considerable prevalence of MDE among tertiary health care workers; reviewing work processes is essential to reduce occupational stress and minimize the effects of the pandemic on mental health, preventing those problems from becoming chronic.

Cardiovascular risk factors and major depressive disorder: a cross-sectional study in São Paulo, Brazil

ABSTRACT BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

Prevalência do transtorno depressivo maior em pessoas com dependência química / Prevalence of major depressive disorder in people with chemical addiction / Prevalencia del trastorno depressive major en personas con adicción

OBJETIVO: verificar a prevalência do Transtorno Depressivo Maior em pessoas com dependência química. MÉTODO: estudo transversal com a aplicação da entrevista estruturada para os transtornos do DSM-V em 183 indivíduos internados em comunidades terapêuticas de acolhimento para dependentes químicos, localizadas no sul de Santa Catarina, durante o de ano de 2019. RESULTADOS: todos os participantes não realizaram consulta psiquiátrica ao ingressar na instituição e a maioria não realizou consulta psiquiátrica regular (94,5%). Constatou-se que 89 participantes (55,3%) possuíam critérios diagnósticos para o Transtorno Depressivo Maior e 59,1% destes possuíam adicção ao álcool (p<0,028). CONCLUSÃO: o diagnóstico do transtorno depressivo deve-se consolidar como uma variável importante para a eficácia do tratamento, visto que sua prevalência é elevada e possui repercussões sobre a qualidade do tratamento e tempo de institucionalização.

OBJECTIVE: to verify the prevalence of Major Depressive Disorder in people with chemical dependence. METHOD: cross-sectional study with the application of the structured interview for the DSM-V disorders in 183 individuals admitted to therapeutic communities for chemical dependents, located in the south of Santa Catarina, during the year 2019. RESULTS: All participants did not have a psychiatric consultation when entering the institution and the majority did not have a regular psychiatric consultation (94.5%). It was found that 89 participants (55.3%) had diagnostic criteria for Major Depressive Disorder and 59.1% of these had alcohol addiction (p<0.028). CONCLUSION: the diagnosis of depressive disorder should be consolidated as an important variable for the effectiveness of treatment, since its prevalence is high and has repercussions on the quality of treatment and time of institutionalization.

OBJECTIVO: verificar la prevalencia del transtorno depressivo major en personas con adicción. METODO: estudio transversal con aplicación de la entrevista estructurada para los transtornos del DSM-V en 183 personas internadas en comunides de tratamiento de adicción en el departamento de Santa Catarina durante el ano de 2019. RESULTADOS: la totalidad de los pacientes no realizaron cita con psiquiatra al ingressar en las instituiciones y la mayoria no realiza visitas regulares al psiquiatra (94,5%). Se observó que 89 participantes (55,3%) tenian critérios diagnósticos para depressión y 59,1% de ellos eram adictos al álcohol (p<0,028). CONCLUSIÓN: el diagnóstico del transtorno depressivo debe consolidarse como una variable importante para la eficácia del tratamiento, pues su prevalencia es elevada y pose repercursiones sobre la calidad del tratamiento y el tiempo de permanencia en las comunidades.

Major depressive disorder in detention officers / Transtorno depressivo maior em agentes penitenciários

ABSTRACT OBJECTIVE To identify factors associated with major depressive disorder (MDD) in detention officers. METHODS This cross-sectional study included all detention officers from the largest prison complex in the state of Bahia, Brazil. A self-reported questionnaire collected sociodemographic, occupational and health data. The outcome variable - MDD - was evaluated by the Patient Health Questionnaire-9 (PHQ-9) and classified by the cut-off point ≥ 10 method and the algorithm method. The association measure used was the prevalence ratio (PR). Following Cox multivariate regression, the variables were divided into two blocks: sociodemographic characteristics and work, in that order. Only variables with adjusted PR (PRadj) ≥ 1.30 were selected to compose the final models. RESULTS The MDD prevalence by the cut-off point ≥ 10 (simple) and algorithm method in the 401 officers investigated was 18.8% and 9.3%, respectively. MDD prevalence by cut-off point ≥ 10 was higher in female officers (PRadj = 2.77), who suffered threat from factions (PRadj = 2.05), did not report institutional training for the position (PRadj = 1.38), stated that the environment and working conditions interfered in their physical health (PRadj = 3.51) and performed stress-generating activities (PRadj in increasing gradient). MDD prevalence by the algorithm method was higher in female agents (PRadj = 3.45), with tertiary education (PRadj = 1.71), who stated that the environment and working conditions interfered in their physical health (PRadj = 6.33), suffered threat from factions (PRadj = 2.14), did not report institutional training (PRadj = 1.50) and have frequent contact with inmates at work (PRadj = 1.48). CONCLUSION The high MDD prevalence in these detention officers was associated with sociodemographic factors and, especially, aspects of their work.

RESUMO OBJETIVO Identificar fatores associados a transtorno depressivo maior (TDM) em agentes penitenciários. MÉTODOS Este estudo de corte transversal incluiu todos os agentes penitenciários do maior complexo prisional do estado da Bahia (Brasil). Num questionário autoaplicado, coletaram-se informações sociodemográficas, ocupacionais e de saúde. A variável de desfecho - TDM - foi avaliada pelo Patient Health Questionnaire-9 (PHQ-9) e classificada pelo método do ponto de corte ≥ 10 e pelo método de algoritmo. A razão de prevalência (RP) foi a medida de associação utilizada. Conforme regressão multivariada de Cox, as variáveis foram inseridas em dois blocos: características sociodemográficas e aspectos do trabalho, nessa ordem. Apenas as variáveis com RP ajustada (RPaj) ≥ 1,30 foram selecionadas para compor os modelos finais. RESULTADOS Nos 401 agentes investigados, a prevalência de TDM pelo ponto de corte ≥ 10 (simples) e pelo método de algoritmo foi de 18,8% e 9,3%, respectivamente. A prevalência de TDM pelo ponto de corte ≥ 10 foi maior em agentes do sexo feminino (RPaj = 2,77), que sofreram ameaça de facções (RPaj = 2,05), que não referiram treinamento institucional para o cargo (RPaj = 1,38), que afirmaram que o ambiente e as condições de trabalho interferiam na sua saúde física (RPaj = 3,51) e que exerciam atividades geradoras de tensão (RPaj em gradiente crescente). A prevalência de TDM pelo método de algoritmo foi mais elevada em agentes do sexo feminino (RPaj = 3,45), com escolaridade superior (RPaj = 1,71), que afirmaram que o ambiente e as condições de trabalho interferiam na sua saúde física (RPaj = 6,33), que sofreram ameaça de facções (RPaj = 2,14), que não referiram treinamento institucional (RPaj = 1,50) e que têm contato frequente com internos no trabalho (RPaj = 1,48). CONCLUSÃO A alta prevalência de TDM nesses agentes penitenciários associou-se a aspectos sociodemográficos e, principalmente, a aspectos do seu trabalho.

Brain network analysis of adolescent depression with attempted suicide / 中国医学影像技术

Objective: To explore the changes of the graph theory metrics and the functional connectivity (FC) of adolescent depression with attempted suicide. Methods: Resting-state functional MRI (rs-fMRI) data of 33 patients of adolescent depression with attempted suicide (attempted suicide group), 40 patients of adolescent depression without attempted suicide (no suicide group) and 52 normal adolescents (NC group) were collected, and a binary network was constructed. The brain regions changed in the graph theory attribute were selected as the seeds, and FC between seed and all the other voxels within the whole brain was computed and compared among groups. Results: There were small world attributes in all subjects. Compared with NC group, the degree of centrality significantly decreased in adolescent depression patients (P<0.01), and there were negative correlations between the decreased degree of centrality and Hamilton Depression Scale scores (r=-0.31, P<0.01). Compared with NC group, FC of the somatomotor networks and the salience network decreased in adolescent depression patients, while FC of the attention network in attempted suicide group increased than in no suicide group (all TFCE correction, P<0.05). Conclusion: Decrease of visual network information transmission ability in patients of adolescent depression is related to the severity of depression. The abnormal attention space ability caused by the attention network lesions may be the pathological mechanism of suicidal attempt in patients of adolescent depression.

Transtorno depressivo maior em idosos não institucionalizados atendi-dos em um centro de referência / Major depressive disorder in non-institutionalized elderly persons at a reference center

Introdução: A depressão exerce um impacto importante na qualidade de vida dos idosos, sendo imprescindível a compreensão dos fatores de risco para o desenvolvimento da doença, para que profissionais de saúde atuem no planejamento e implementação de ações direcionadas à promoção de saúde desse público. Objetivo:Analisar a prevalência de transtorno depressivo maior em idosos atendidos em um centro de referência do norte de Minas Gerais, avaliando associações com fatores de risco sociodemográficos. Material e Métodos: Realizou-se um estudo transversal e documental, a partir de 3362 prontuários de pacientes atendidos no Centro de Referência em Montes Claros, Minas Gerais, Brasil, no período entre janeiro de 2008 e dezembro de 2011. Para análise do quadro de depressão, foram utilizados dados do diagnóstico a partir do DSM-IV. Foram realizados testes de qui-quadrado e exato de Fisher para determinar fatores sociodemográficos associados àocorrência de depressão. Resultados:Odiagnóstico de transtorno depressivo maior esteve presente na maioria dos idosos (56,8%). Foi encontrada associação estatisticamente significativa na presença de transtorno depressivo maior em idosos do sexo feminino (p<0,001), não casados (p<0,001) e não alfabetizados (p<0,002). Não houve relação estatisticamente significativa entre as variáveis idade e presença de transtorno depressivo maior nos idosos estudados (p=0,599). Conclusão:Aalta prevalência do transtorno depressivo maior nos idosos desta pesquisa, bem como a identificação dos fatores associados chama atenção para necessidade de políticas de atenção voltadas para prevenção e detecção precoce do transtorno depressivo maior, de forma a atender a suas demandas e proporcionar uma longevidade com qualidade de vida.

Introduction: Depression has an important impact on thequality of life of older people. It is imperative to understand the risk factors to the development of the disease. This understanding is critical to health professionals,once they have to plan and implement actions aimed at health promotion for that population. Objective: Analyze the prevalence of major depressive disorder in older peopleattending a reference center in the North of Minas Gerais State, in order to establish associations among the disorder andsociodemographic risk factors.Material andMethods:We conducted a cross-sectionaland documentary study from 3362 records of patients treated at a Reference Center in the city of Montes Claros, Minas Gerais State, Brazil from January 2008 to December 2011. For depression condition analysis, we used the categorical classification of mental disorders (DSM-IV). We used Fisher's exact test and chi-square test to determine sociodemographic factors associated with depression.Results: The majority of older people (56.8%) were diagnosed with major depressive disorder. A statistically significant association was found between major depressive disorder and female (p <0.001), unmarried (p<0.001) and non-literate (p<0.002)older people. There was no statistically significant relation between age and the presence of major depressive disorder (p=0.599).Conclusion: The high prevalence of major depressive disorder found among older people, as well as the identification of associated factors, draws attention to the need for attention policies aimed at prevention and early detection of major depressive disorder in order to meet their demands and provide longevity with quality of life.

Temperament and character traits in major depressive disorder: a case control study

ABSTRACT BACKGROUND: Patients with major depressive disorder (MDD) have distinct personality traits, compared with control subjects, although the role of anxiety and positive and negative affects in this finding is unclear. DESIGN AND SETTING: A case-control study enrolling 103 antidepressant-free depressed patients and 103 age and gender-matched controls was conducted at the University Hospital, University of São Paulo. METHODS: The self-reported scales of the Positive and Negative Affect Schedule (PANAS), State-Trait Anxiety Inventory (STAI) and Cloninger's Temperament and Character Inventory (TCI) were applied. Temperament and character traits were compared between groups using multivariate and bivariate analyses of variance (MANOVA and ANOVA). The influence of anxiety and affect was further investigated using ANOVA and mediation analyses. RESULTS: Depressed patients presented higher harm avoidance and lower self-directedness scores than controls. After adjustment for anxiety trait, harm avoidance was no longer significantly different between groups. Mediation analysis revealed that the anxiety trait, but not state-anxiety or affect, fully mediated the influence of group (depressed versus control subjects) on harm avoidance. CONCLUSIONS: Our findings confirm that depressed patients present personality traits distinct from those of controls and suggest that MDD is not directly associated with harm avoidance, but that this effect is fully mediated through the anxiety trait.

Major Depression and Acute Coronary Syndrome-Related Factors / Depressão Maior e Fatores Relacionados na Síndrome Coronariana Aguda

Abstract Background: Major Depressive Disorder (MDD) is one of the most common mental illnesses in psychiatry, being considered a risk factor for Acute Coronary Syndrome (ACS). Objective: To assess the prevalence of MDD in ACS patients, as well as to analyze associated factors through the interdependence of sociodemographic, lifestyle and clinical variables. Methods: Observational, descriptive, cross-sectional, case-series study conducted on patients hospitalized consecutively at the coronary units of three public hospitals in the city of Rio de Janeiro over a 24-month period. All participants answered a standardized questionnaire requesting sociodemographic, lifestyle and clinical data, as well as a structured diagnostic interview for the DSM-IV regarding ongoing major depressive episodes. A general log-linear model of multivariate analysis was employed to assess association and interdependence with a significance level of 5%. Results: Analysis of 356 patients (229 men), with an average and median age of 60 years (SD ± 11.42, 27-89). We found an MDD point prevalence of 23%, and a significant association between MDD and gender, marital status, sedentary lifestyle, Killip classification, and MDD history. Controlling for gender, we found a statistically significant association between MDD and gender, age ≤ 60 years, sedentary lifestyle and MDD history. The log-linear model identified the variables MDD history, gender, sedentary lifestyle, and age ≤ 60 years as having the greatest association with MDD. Conclusion: Distinct approaches are required to diagnose and treat MDD in young women with ACS, history of MDD, sedentary lifestyle, and who are not in stable relationships.

Resumo Fundamento: O transtorno depressivo maior (TDM) é um dos distúrbios mentais mais comuns em psiquiatria, sendo um fator de risco para síndrome coronariana aguda (SCA). Objetivo: Avaliar a prevalência de TDM em pacientes com SCA, assim como analisar os fatores associados através da interdependência de variáveis sociodemográficas, clínicas e de estilo de vida. Métodos: Estudo observacional, descritivo e transversal conduzido em pacientes hospitalizados consecutivamente nas unidades coronarianas de três hospitais públicos na cidade do Rio de Janeiro num período de 24 meses. Todos os participantes responderam a um questionário padrão sobre dados sociodemográficos, clínicos e de estilo de vida, assim como participaram de uma entrevista clínica estruturada do DSM-IV sobre episódio depressivo maior atual. Aplicou-se um modelo log-linear de análise multivariada para avaliar associação e interdependência, com nível de significância de 5%. Resultados: Análise de 356 pacientes (229 homens) com idade média e mediana de 60 anos (DP ± 11,42; 27-89). Encontrou-se uma prevalência pontual de TDM de 23%, e significativa associação de TDM com as variáveis sexo, estado civil, sedentarismo, classificação Killip e história de TDM. Ao controlar por sexo, observou-se associação estatisticamente significativa entre TDM e sexo, idade ≤ 60 anos, sedentarismo e história de TDM. O modelo log-linear identificou as variáveis história de TDM, sexo, sedentarismo e idade ≤ 60 anos como tendo a maior associação com TDM. Conclusão: Os resultados indicam a necessidade de abordagens distintas para diagnosticar e tratar TDM em mulheres jovens com SCA, história de TDM, sedentarismo e que não estejam em relações estáveis.

Mindfulness-Based Cognitive Therapy in Major depressive disorder - systematic review and metanalysis / Relação entre a Mindfulness-Based Cognitive Therapy e seu efeito no transtorno depressivo maior

Abstract Introduction: MBCT practices increases the ability of concentration and attention, as well is particularly effective for people with current and treatment-resistant depression. Objective: To analyze the effects of the application of MBCT in symptoms of MDD. Methods: systematic review and meta-analysis. To find suitable studies, we searched PubMed/MEDLINE's database using the keywords mindfulness and major depressive disorder. Studies in English published between 2003 and 2015 were selected. The studies were evaluated according to their methodological quality by PEDro scale (score greater than 3), studies that showed empirical evidence, had an experimental study design (randomized and non-randomized), and whose full text was available. For the meta-analysis, we used a random-effects model with standardized mean differences and 95% confidence intervals. Results: Fourteen es were included, of which three were non-randomized, with only one group with intervention of MBCT, and 11 were randomized studies, divided into two-group samples and three-group samples. The non-randomized studies showed a PEDro score of 5, while the two-group and three-group randomized studies showed PEDro scores of 5-10 and 6-9, respectively. In the meta-analysis, the four randomized studies selected revealed a moderate effect of MBCT on the outcome of depression symptoms, with a mean difference of -0.52 (95% CI: -1.050 to -0.002; p = 0.04). Conclusion: The MBCT presented as a promising alternative for the treatment of this disorder.

Resumo Introdução: MBCT práticas aumenta a capacidade de concentração e de atenção, assim é particularmente eficaz para as pessoas com depressão recorrente e resistentes ao tratamento. Objetivo: analisar os efeitos da aplicação da MBCT nos sintomas do Transtorno Depressivo Maior (TDM). Metódos: Revisão sistemática e metanálise. Utilizou-se para a busca dos estudos, a base de dados MEDLINE (PubMed), com os descritores mindfulness e major depressive disorder. Selecionaram-se artigos na língua inglesa entre os anos de 2003 a 2015. Os estudos foram avaliados quanto sua qualidade metodológica pela escala Pedro (pontuação maior que 3), que demonstrassem evidência empírica, com design de estudo experimental (randomizado e não randomizado) e estar disponível na íntegra. Para a metanálise utilizou-se modelo de efeitos aleatórios com diferenças médias padronizadas e intervalos de confiança de 95%. Resultados: Quatorze estudos foram incluídos, sendo 03 não randomizados, contendo apenas um grupo de intervenção da MBCT e 11 estudos randomizados, divididos em amostras de dois grupos e amostras de três grupos. Os estudos não randomizados apresentaram escala Pedro de 5 pontos, os randomizados de dois grupos (de 5 a 10 pontos) e de três grupos (de 6 a 9 pontos). Na metanálise os quatro 4 estudos randomizados selecionados, revelaram um efeito moderado da MBCT sobre o desfecho dos sintomas da depressão, com uma diferença média de -0.52 (IC 95%: -1.050 a -0.002; p = 0.04). Conclusão: A MBCT apresenta-se como uma alternativa promissora para tratamento desse transtorno.

Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment / 전남의대학술지

Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term “mixed episode” was dropped and replaced by “mixed features” specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders. This paradigm shift reflected their significance in the prognosis and overall management of mood disorders, so that the clinicians should thoroughly familiarize themselves with the contemporary notions surrounding these conditions. The purpose of this manuscript is to bring to light the current conceptualizations regarding the etiology, pathogenesis and treatment of mixed states. To achieve this goal, in June 2016 an extensive literature search was undertaken using the PubMed database. Some exploratory terms utilized included “mixed states”, “mixed episodes”, “switching”, “rapid cycling” cross referenced with “bipolar disorder”. Focusing on the most relevant and up to date studies, it was revealed that mixed states result from genetic susceptibility in the circadian and dopamine neurotransmission apparatuses and disturbance in the intricate catecholamine-acetylcholine neurotransmission balance which leads to mood fluctuations. The management of mixed states is challenging with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy emerging as the foremost treatment options. In conclusion, while progress has been made in the neurobiological understanding of mixed states, the currently available therapeutic modalities have only shown limited effectiveness.

Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment / 전남의대학술지

Many bipolar disorder patients exhibit mixed affective states, which portend a generally more severe illness course and treatment resistance. In the previous renditions of Diagnostic and Statistical Manual mixed states were narrowly defined in the context of bipolar I disorder, but with the advent of DSM-5 the term “mixed episode” was dropped and replaced by “mixed features” specifier which could be broadly applied to manic, hypomanic and depressive episodes in both the bipolar spectrum and major depressive disorders. This paradigm shift reflected their significance in the prognosis and overall management of mood disorders, so that the clinicians should thoroughly familiarize themselves with the contemporary notions surrounding these conditions. The purpose of this manuscript is to bring to light the current conceptualizations regarding the etiology, pathogenesis and treatment of mixed states. To achieve this goal, in June 2016 an extensive literature search was undertaken using the PubMed database. Some exploratory terms utilized included “mixed states”, “mixed episodes”, “switching”, “rapid cycling” cross referenced with “bipolar disorder”. Focusing on the most relevant and up to date studies, it was revealed that mixed states result from genetic susceptibility in the circadian and dopamine neurotransmission apparatuses and disturbance in the intricate catecholamine-acetylcholine neurotransmission balance which leads to mood fluctuations. The management of mixed states is challenging with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy emerging as the foremost treatment options. In conclusion, while progress has been made in the neurobiological understanding of mixed states, the currently available therapeutic modalities have only shown limited effectiveness.

Serotonin transporter gene ( 5-HTT ) polymorphism and major depressive disorder in patients in Bogotá, Colombia / Polimorfismo del gen del transportador de serotonina ( 5-HTT ) y trastorno de depresión mayor en pacientes en Bogotá, Colombia

Introduction: The 5-HTT short allele has been controversially associated with an increased risk of major depressive disorder. Objective: To determine the association of 5-HTT short allele with major depression in Bogotá, Colombia. Materials and methods: We carried out a study of cases (n=68) matched 1:1 with controls by gender and age (±5 years). Major depression was diagnosed using the Mini-International Neuropsychiatric Interview, and 5-HTT polymorphism using PCR. Results: Females were predominant (82.4%). The S (short) allele predominated in cases compared with controls (S: 72.1% vs. 63.2; L (long): 27.9% vs. 36.8%), and the SL genotype was more frequent in cases (SL: 45.6% vs. 36.8%; LL: 27.9% vs. 36.8%; SS: 26.5% vs. 26.5%), although not significantly. There were significant differences in those under age 37, with a predominance of the S allele in cases (p=0.038; OR=2.75; 95% CI: 0.88-8.64). Multivariate analysis, adjusted for comorbid anxiety disorders, showed a significant association of major depression with the SL genotype (p=0.049; OR=3.20; 95% CI: 1.00-10.23); the S allele was close to statistical significance (p=0.063; OR=2.94; 95% CI: 0.94-9.13), and it was statistically significant in cases under 37 years of age (p=0.026; OR=10.79; 95% CI: 1.32-80.36). Conclusions: The SL genotype was associated with major depressive disorder in patients of all ages. The S allele was significantly associated with major depressive disorder in patients under age 37, adjusted for comorbid anxiety disorders.

Introducción. El polimorfismo 5-HTT se ha asociado con el trastorno de depresión mayor, aunque el planteamiento ha generado controversia. Objetivo. Determinar la asociación del polimorfismo 5-HTT con la depresión mayor en Bogotá, Colombia. Materiales y métodos. Se hizo un estudio de casos y controles pareado por sexo y edad (±5 años), con una razón de uno a uno (68:68). El trastorno de depresión mayor se diagnosticó con el cuestionario Mini-International Neuropsychiatric Interview, y, el polimorfismo 5-HTT , mediante reacción en cadena de la polimerasa (PCR). Resultados. Las mujeres predominaron entre los participantes (82,4 %). El alelo corto ( short , S) predominó en los casos comparados con los controles (S: 72,1 % Vs . 63,2; L ( long ): 27,9 % Vs . 36,8 %), y el genotipo SL fue más frecuente en los casos (SL: 45,6 % Vs . 36,8 %; LL: 27,9 % Vs . 36,8 %; SS: 26,5 % Vs . 26,5 %), aunque no significativamente. Hubo diferencias significativas en menores de 37 años, con predominio del alelo S en los casos (p=0,0384; odds ratio - OR=2,75; IC 95% : 0,88-8,64). El análisis multivariado ajustado por trastornos concomitantes de ansiedad mostró una asociación significativa de la depresión mayor con el genotipo SL (p=0,049; OR=3,20; IC 95% 1,003-10,233); el alelo S estuvo cerca de la significación estadística (p=0,063; OR=2,94; IC 95% 0,94-9,13), y fue estadísticamente significativo en los casos de menores de 37 años (p=0,026; OR=10,79; IC 95% 1,32-80,36). Conclusiones. El genotipo SL se asoció con el trastorno de depresión mayor en pacientes de todas las edades. El alelo S se asoció significativamente con el trastorno de depresión mayor en pacientes menores de 37 años al ajustar por trastornos concomitantes de ansiedad.

Family functioning in adolescents with major depressive disorder: a comparative stud / Dinâmica familiar de adolescentes com transtorno depressivo maior: um estudo comparativo

The goal of this study was to evaluate family functioning in two groups of adolescents: adolescents with major depressive disorder (cases) and adolescents with no psychiatric disorders (controls). A total of 18 adolescents (13-18 years) and their first-degree relatives (N = 70) were evaluated. Cases and controls were matched for the adolescent's age, gender, level of education, number and age of siblings, parental marital status, and economic condition. A family therapist conducted the Structured Family Interview with each family to evaluate nine family functioning dimensions (communication, rules, roles, leadership, conflict, aggressiveness, affect, individuation, and integration). The interview transcripts were independently rated by two different family therapists blinded to case-control status, i.e., without knowing whether they were evaluating cases or controls. The raters scored all interview items using a standardized coding system (overall agreement = 83.5%), and when compared to the controls, the cases showed lower mean scores in seven dimensions, particularly affect (p = 0.0078). There was no difference between cases and controls regarding the dimensions rules and leadership. Difficulty in expressing affect in parent-child relationship was the main disturbance in the families of depressive adolescents evaluated.

Avaliar a dinâmica familiar em dois grupos de adolescentes, um com transtorno depressivo maior (casos) e outro sem transtornos psiquiátricos (controles), totalizando 18 adolescentes (13-18 anos) acompanhados de seus pais e irmãos (N = 70). Pareou-se casos e controles segundo idade, sexo, escolaridade, número e idade dos irmãos, estado civil parental e condição econômica. Uma terapeuta familiar aplicou a Entrevista Familiar Estruturada a cada família, avaliando nove dimensões da dinâmica familiar (comunicação, normas, papéis, liderança, conflito, agressividade, afeto, individualização, integração). As sessões transcritas foram independentemente avaliadas por duas outras terapeutas familiares que desconheciam se as famílias constituíam casos ou controles. A pontuação dos itens da entrevista baseou-se em um sistema de codificação padronizado (concordância geral = 83,5%). Comparados aos controles, os casos obtiveram médias de escores mais baixas em sete dimensões, especialmente afeto (p = 0,0078); não houve diferença nas dimensões normas e liderança. A dificuldade em expressar afeto nas relações entre pais e filhos foi a principal disfunção nas famílias dos adolescentes deprimidos avaliados.

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial / Estudo clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS): racional e desenho de estudo de um ensaio de não inferioridade, de três braços, placebo-controlado

CONTEXT AND OBJECTIVE: Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING: Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS: ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS: Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION: Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression. .

CONTEXTO E OBJETIVO: O transtorno depressivo maior (TDM) é uma condição psiquiátrica comum, tratada com medicamentos antidepressivos, os quais são limitados devido à refratariedade e efeitos adversos. Descrevemos o racional e o desenho do Estudo Clínico Escitalopram versus Eletroterapia no Tratamento da Depressão (ELECT-TDCS), que investiga um tratamento não farmacológico, conhecido como estimulação transcraniana por corrente contínua (ETCC). DESENHO E LOCAL: Ensaio de fase III, randomizado, de não inferioridade, de três braços, placebo-controlado, em execução em São Paulo, Brasil. MÉTODOS: O estudo compara a eficácia da ETCC ativa/pílula placebo, ETCC simulada/escitalopram 20 mg/dia e ETCC simulada/pílula placebo durante 10 semanas, randomizando 240 pacientes em uma proporção 3:3:2, respectivamente. O objetivo principal é demostrar que a ETCC não é inferior ao escitalopram com uma margem de não inferioridade de pelo menos 50% do efeito de escitalopram em relação ao placebo. Como objetivos secundários, investigamos biomarcadores como polimorfismos genéticos, marcadores séricos, excitabilidade cortical motora, variabilidade da frequência cardíaca e neuroimagem. RESULTADOS: Provar que ETCC é igualmente eficaz a antidepressivos teria um tremendo impacto na psiquiatria clínica, uma vez que a ETCC é praticamente isenta de efeitos adversos. Sua facilidade de uso, portabilidade e preço baixo são outras características atraentes para uso na atenção primária e secundária de saúde. A investigação multimodal de biomarcadores também contribuirá para a compreensão dos mecanismos de ação antidepressivos da ETCC. CONCLUSÃO: Os nossos resultados podem introduzir uma nova técnica no arsenal terapêutico do tratamento da depressão. .

Gender Differences in Depressive Symptom Profile: Results from Nationwide General Population Surveys in Korea

This study investigated gender differences in symptom profiles of major depressive disorder (MDD) in the Korean general population. Data were pooled from the series of nationwide Korean Epidemiologic Catchment Area surveys conducted in 2001, 2006 and 2011, respectively. Of the 18,807 participants, 507 (397 women and 110 men) were diagnosed with MDD within the prior 12 months. In agreement with previous studies, women with MDD appeared to be more vulnerable to experiencing atypical depressive episodes defined as depression with two or more symptoms of fatigue, increased appetite and hypersomnia (P < 0.001). In terms of individual symptoms, female gender was significantly related with higher prevalence of fatigue (P = 0.008), hypersomnia (P = 0.001), noticeable psychomotor retardation (P = 0.029) and suicidal attempts (P = 0.016) with adjustment for birth cohort effect, partner status, and employment status. In the same analysis, men with MDD appeared more vulnerable to decreased libido than women (P = 0.009). This is the first report to demonstrate gender differences in symptomatology of MDD in the general Korean population, and the results are comparable to previous investigations from western societies. Assumingly, the intercultural similarity in female preponderance to atypical depression might reflect the common biological construct underlying the gender difference in mechanism of MDD. In clinical settings, gender differences of MDD should be carefully considered, because these features could be related with treatment response and drug side effects.

Optimizing the Use of Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: From Clinical Trials to Clinical Practice / 전남의대학술지

Major depressive disorder (MDD) is a recurrent, chronic, and devastating disorder leading to serious impairment in functional capacity as well as increasing public health care costs. In the previous decade, switching therapy and dose adjustment of ongoing antidepressants was the most frequently chosen subsequent treatment option for MDD. However, such recommendations were not based on firmly proven efficacy data from well-designed, placebo-controlled, randomized clinical trials (RCTs) but on practical grounds and clinical reasoning. Aripiprazole augmentation has been dramatically increasing in clinical practice owing to its unique action mechanisms as well as proven efficacy and safety from adequately powered and well-controlled RCTs. Despite the increased use of aripiprazole in depression, limited clinical information and knowledge interfere with proper and efficient use of aripiprazole augmentation for MDD. The objective of the present review was to enhance clinicians' current understanding of aripiprazole augmentation and how to optimize the use of this therapy in the treatment of MDD.

Optimizing the Use of Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: From Clinical Trials to Clinical Practice / 전남의대학술지

Major depressive disorder (MDD) is a recurrent, chronic, and devastating disorder leading to serious impairment in functional capacity as well as increasing public health care costs. In the previous decade, switching therapy and dose adjustment of ongoing antidepressants was the most frequently chosen subsequent treatment option for MDD. However, such recommendations were not based on firmly proven efficacy data from well-designed, placebo-controlled, randomized clinical trials (RCTs) but on practical grounds and clinical reasoning. Aripiprazole augmentation has been dramatically increasing in clinical practice owing to its unique action mechanisms as well as proven efficacy and safety from adequately powered and well-controlled RCTs. Despite the increased use of aripiprazole in depression, limited clinical information and knowledge interfere with proper and efficient use of aripiprazole augmentation for MDD. The objective of the present review was to enhance clinicians' current understanding of aripiprazole augmentation and how to optimize the use of this therapy in the treatment of MDD.

Avances en el estudio de la neurobiología de la depresión: rol de la hormona concentradora de melanina / Progress made in studies in the neurobiology of depression: a role for the melanin-concentrating hormone

Introducción: la depresión mayor (DM) es una enfermedad psiquiátrica frecuente, con importante morbilidad y una relación estrecha con el suicidio. Objetivo: hacer una puesta a punto de los avances en el estudio de la neurobiología de la DM, enfocándonos en el posible rol de la hormona concentradora de melanina (MCH) en esta patología. Metodología: revisión de la bibliografía con énfasis en nuestros propios trabajos originales. Resultados: la MCH es un neuromodulador peptídico sintetizado por neuronas del hipotálamo. Las neuronas MCHérgicas envían proyecciones hacia diversas regiones del sistema nervioso central, incluyendo las áreas vinculadas con la regulación de la vigilia y del sueño, así como a diversas estructuras del sistema límbico que participan en la regulación del humor. Aunque numerosos estudios han relacionado el sistema MCHérgico con el control de la homeostasis energética, hallazgos recientes han permitido señalar un rol de este sistema en los mecanismos de generación del sueño. A su vez, una convergencia de datos provenientes de diversos estudios sugiere que la MCH estaría involucrada en la fisiopatología de la DM. Nuestros propios estudios preclínicos tienden a indicar que la MCH promueve la generación del sueño REM y un estado tipo depresivo. Ambos efectos estarían siendo mediados a través de la modulación de la actividad de las neuronas serotoninérgicas del núcleo dorsal del rafe. Conclusiones: estudios preclínicos sugieren un rol protagónico del sistema MCHérgico en la fisiopatología de la depresión. Resta confirmar si esta afirmación es cierta en pacientes con DM...