Protocol and Rationale-The Efficacy of Minocycline as an Adjunctive Treatment for Major Depressive Disorder: A Double Blind, Randomised, Placebo Controlled Trial

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functional recovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation of novel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotective properties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctive trial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctive treatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (with a 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational Functioning Assessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient Global Impression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool (LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide new treatment targets, both by showing efficacy with a new class of 'antidepressant' but also through the analysis of biomarkers that may further inform our understanding of the pathophysiology of unipolar depression.

Prevalence of depression, hemoglobin A1C level, and associated factors in outpatients with type-2 diabetes

Background: The prevalence of type-2 diabetes is increasing worldwide. Glycemic control has been demonstrated to reduce the morbidity and mortality in patients with type-2 diabetes. Several factors determine the glycemic control, and include the psychological factor, particularly depression. Objectives: To estimate the prevalence of depression, and poor glycemic control, and to determine the associated factors in outpatients with type-2 diabetes. Material and method: A cross-sectional study was conducted in 250 participants at endocrine clinic of King Chulalongkorn Memorial Hospital between June and December 2008. Participants completed the questionnaire and tests for socio-demographic characteristics and medical information, Thai-HADS, the Thai Mental State Examination (TMSE), Montreal Cognitive Assessment (MoCA) Test, Summary of Diabetes Self-Care Activities (SDSCA), Life Events Stress test, and questionnaire for assessment of social support. Results: Approximately 64% of the samples were female with the mean age of 63 years, and 54% had at least 12-year education. The prevalence of depression in patients with type-2 diabetes was 28%, and of poor glycemic control (hemoglobin A1C ≥7%) was 56%. Depression and poor glycemic control showed a linear relationship if depression scores in Thai-HADS were more than 12. Multivariate analysis indicated that the significant risk factors associated with depression were anxiety, low education level, history of diabetes related admissions, perceived deteriorating health status, non-adherence to DM treatment, and diabetic nephropathy. The significant risk factors associated with poor glycemic control were no hypertension, diabetic retinopathy, perceived deteriorating health status, coffee drinking, high serum LDL, and albuminuria or proteinuria. Conclusion: Among patients with type-2 diabetes, poor glycemic control and depression were prevalent. Marked depression might be associated with poor glycemic control. Health care providers should monitor and early detect of such conditions, particular in patients with the significant risk factors to reduce morbidity and mortality holistically in long-term care.

Association between depression and adherence to highly active antiretroviral therapy among adult HIV infected patients in Thailand

Background: Highly active antiretroviral therapy (HAART) reduces the morbidity and mortality in HIV-infected patients by enhancing the immunologic response and viral load suppression. Non-adherence to HAART leads to development of resistance mutation resulting in treatment failure. Depression is a common psychological problem among HIV-infected patients. However, the association between depression and adherence to HAART has not been studied in Thailand.Objectives: To estimate the prevalence of non-adherence to HAART and to determine the association of depression and related factors with adherence to HAART in Thai adult HIV-infected patients.Material and method: A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital, Thailand between October 2007 and January 2008. Three hundred seventy nine participants were recruited from the immunology and sexual transmitted disease clinics. Participants completed seven questionnaires regarding socio-demographic characteristics and medication information, adherence to HAART, depression, cognitive function, alcohol use, HIV social support, and physical symptoms.Results: The prevalence of non-adherence to HAART was 34.6% and the prevalence of depression among adult HIV-infected patients was 32.2%. The statistically significant risk-factors associated with non-adherence were depression (adjusted OR=4.68; 95%CI=2.77-7.88), no past history of opportunistic infection (OR=2.13; 95%CI=1.26-3.63), using herbal medications (OR=2.44; 95%CI=1.07-5.55), and never getting a reminder of adherence to HAART (OR=2.78; 95%CI=1.29-5.98).Conclusion: Depression was a strong predictor for non-adherence to HAART among Thai HIV-infected patients. Health care providers should screen for depression among HIV-infected patients before starting HAART and motivate those with depression on adherence to HAART.