Comparing the Anti-Depressive Effect of Electroconvulsive Therapy (ECT) Versus Transcranial Magnetic Stimulation (TMS) in the Treatment of Patients with Depression.

BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective treatments for depressive disorders. However, ECT has a number of limitations, such as significant side effects in the neurocognitive domain and the requirement for general anesthesia. Transcranial magnetic stimulation (TMS) is an intervention that applies electric stimulation to the brain without causing convulsions, thus representing an attractive alternative to ECT. The aim of our study is to review systematic reports of the effectiveness of ECT and TMS in the treatment of depressive spectrum disorders. SUBJECTS AND METHODS: We performed search queries in PubMed and eLibrary databases, which retrieved 391 articles, of which 14 met our inclusion criteria for the analysis. The articles comprised three comparisons: TMS vs SHAM, ECT vs sham ECT (SECT), and ECT vs PHARM. The protocol parameters analyzed for TMS were coil type, targeted brain area, amplitude of resting motor threshold, duration of session, number of sessions in total and per week, number and pulses per session and inter-train pause. For ECT, we evaluated the type of ECT device, targeted brain area, type of stimuli, and for ECT vs PHARM we recorded types of anesthesia and antidepressant medication. RESULTS: Three of 6 studies showed a therapeutic effect of TMS compared to placebo; efficacy was greater for TMS frequency exceeding 10 Hz, and with stimulation of two areas of cerebral cortex rather than a single area. There was insufficient data to identify a relationship between the success of TMS and intertrain pause (IP). Three of four studies showed a therapeutic effect of ECT compared to placebo. Three studies of bilateral ECT showed a significant reduction in depression scores compared to the SECT groups. ECT protocols with brief pulses were generally of lesser efficacy. Four of 5 ECT vs PHARM studies showed superior efficacy of ECT compared to PHARM. Among several antidepressants, only the ketamine study showed greater efficacy compared to ECT. CONCLUSIONS: There of six TMS studies and 7 of 9 ECT studies showed efficacy in reducing depressive symptoms. A prospective study of crossover design might reveal the relative efficacies of ECT and TMS.

Social Distance Factor Related to the Level of Mental Health Awareness Among the Clinicians.

BACKGROUND: Stigmatization of morbidity in health care workers, the incidence of disease, the disease that interferes with the disease of medical care. Social distancing by clinicians is an integral part of the stigmatization that depends on the behavior of the patient and the level of awareness of the clinician. METHODS: The modified Bogardus Social Distance Self-Assessment Scale (BSDS) was used to evaluate the indicators of social distance phenomena. The assessment was performed by clinicians for the following groups of patients with the following mental disorders: alcohol use disorder, bipolar disorder, depression, drug addiction, epilepsy, mental retardation, schizophrenia. All statistical calculations were performed using IBM SPSS-27 software (IBM Corp. 2021, licensed to Samara State Medical University). P-value ≤ 0.05 was determined as significant for the between-group (PSY vs NPHP) comparisons using a nonparametric Wilcoxon test. RESULTS: The study included 141 clinicians: PSY (n=20; 36.2±4.2 y.o.) and NPHP (n=121; 25.9±2.2 y.o.). The NPHP group included general practitioners (GP)/physicians (n=29; 20.6%), surgeons (n=19; 13.5%), obstetrician-gynecologists (n=26; 18.4%), neurologists (n=11; 7.8%), pediatricians (n=6; 4.3%), and other subspecialists (including urologists, tuberculosis specialists, ophthalmologists, and dermatologists) (n=30; 21.3%). The study included 141 students at the Samara State Medical University who were trained in psychiatry. An anonymous survey was conducted on the BSDS scale before and after training. Our analysis of the data showed that the social distance of clinicians in terms of coverage reaches different values depending on the mental disorder, but with common trends both before and after the psychiatry training course. Mean (SD) social distance scores recurred from 2.8 (1.3) for bipolar disorder to 5.3 (1.5) for addiction in the predevelopment group and 2.9 (1.3), 5.4 (1.4) in the group of clinicians after training, respectively. CONCLUSIONS: Social distancing scores among clinicians in contemporary Russia were highest for drug addicts, and lowest for depression and bipolar disorder. Stigmatization among clinicians appears to affect the delivery of care to certain categories of patients, which requires further study. Higher social distance scores in patients with drug addiction may be associated with higher stigma and lack of compassion towards these patients. Conversely, lower rates of social distancing and the corresponding emotional acceptance of people with depression and bipolar disorder by clinicians may interfere with timely diagnosis and the availability of appropriate early, treatable care. The awareness of clinicians regarding psychopathological manifestations does not affect the level of social distance, but increases it in relation to mentally healthy individuals with normal behavior.

Dietary Patterns as Modifiable Risk Factors for Depression: a Narrative Review.

BACKGROUND: The role of nutrition in treating clinical depression has been widely discussed. Unhealthy lifestyle patterns, like lack of physical activity, junk food consumption, and irregular sleep patterns are common in depressed patients. Considering the mental and physical side-effects, the daily nutrition of these patients seems to be a plausible option for reducing depressive symptoms and enhancing treatment results. METHODS: A PubMed search was done for meta-analyses published from January 2018 to June 2023 with the query: (diet) AND (psychiatric disorder) AND (depression). We selected meta-analyses that met specific criteria like including the entire diet or specific diet patterns and having depression or depressive symptoms as a primary or secondary outcome. RESULTS: Out of 28 papers found, the 9 meta-analyses, selected for review, revealed different types of correlation between dietary patterns and the symptoms of depression and anxiety. Healthy diets were associated with higher intake of fruits, vegetables, nuts, and lower intake of pro-inflammatory food items like processed meats and trans fats. Adherence to such diets showed a negative association with incident depression in cross-sectional and longitudinal studies. A diet mostly including ultra-processed foods was associated with higher odds of depressive and anxiety symptoms. Women were found to be more susceptible than men both in developing the depressive symptoms with unhealthy diet and in reducing the symptoms of depression and anxiety with improvement of diet quality. Statistically significant improvement in symptoms of depression and anxiety in both sexes was observed in study groups assigned for individual consultations of a dietician and a psychotherapist when compared with group sessions or general recommendations. CONCLUSIONS: Research on the correlation of healthy dietary patterns and symptoms of depression and anxiety has mainly focused on non-clinical populations. The evidence supports an inverse association between healthy eating habits and symptoms of depression. Further research should be encouraged on the eating habits of clinically depressed individuals and the underlying physiological mechanisms of uncontrolled food intake.

Non-Psychiatrist Healthcare Professionals? Attitudes Toward Patients with Mental Disorders: Lower Scores in Social Distance as a Fragile Facet of Public Stigma Against Depression.

BACKGROUND: The stigmatization by healthcare professionals (HP) of patients suffering from mental disorders is an important problem that interferes with the delivery of medical assistance. Social distancing by HP is an integral part of stigmatization, which differs between various mental disorders, as well as between psychiatrists (PSY) versus nonpsychiatrist healthcare professionals (NPHP). SUBJECTS AND METHODS: The study included 141 HP: PSY (n=20; 36.2±4.2 y.o.) and NPHP (n=121; 25.9±2.2 y.o.). The NPHP group included general practitioners (GP)/physicians (n=29; 20.6%), surgeons (n=19; 13.5%), obstetrician-gynecologists (n=26; 18.4%), neurologists (n=11; 7.8%), pediatricians (n=6; 4.3%), and other subspecialists (including urologists, tuberculosis specialists, ophthalmologists and dermatologists) (n=30; 21.3%). The modified Bogardus Social Distance Self-Assessment Scale (BSDS) was used to evaluate the indicators of social distance phenomena. The assessment was performed by HP for the following groups of patients with the following mental disorders: alcohol use disorder, bipolar disorder, depression, drug addiction, epilepsy, mental retardation, personality disorder, schizophrenia. All statistical calculations were performed using IBM SPSS-27 software (IBM Corp. 2021, licensed to Samara State Medical University). P-value ≤0.05 was determined as significant for the between-group (PSY vs NPHP) comparisons using a nonparametric Mann-Whitney U-test. RESULTS: Our data analysis showed that HP achieved varying social distance scores for patients depending on the type of mental disorder, but with common trends among PSY and NPHPs. The mean (SD) scores of social distance ranged from 3.65(1.50) for depression to 5.25 (1.74) for drug addiction in the PSY, versus 3.44 (1.69), 6.19 (1.37) in NPHP, respectively. As compared to PSY, mean BSDS total scores were greater in the NPHP group, notably in the obstetricians-gynecologist - 6.27(1.40), and GP - 6.62 (0.90) groups, with similar trends of differing attitudes appeared among pediatricians - 7.00 (0.01) - regarding drug addiction, whereas the neurologists demonstrated a tendency towards lower social distance in relation to patients with depression - 2.27 (1.68), and epilepsy - 2.82 (1.47). CONCLUSIONS: Social distance measures by PSY and NPHP groups in contemporary Russia were highest in relation to patients with drug addiction, and lowest scores for depression and epilepsy. Stigmatization among HPs seems to influence health care delivery to certain categories of patients, which calls for further investigation. Higher social distance scores for patients with drug addiction might be related to higher stigma and lack of compassion toward these patients. Conversely, lower scores of social distance and corresponding emotional acceptance of people with depression by HP might interfere in the timely diagnosis and availability of appropriate care at an early stage amenable to treatment. This might reflect the cultural context of depressive mentality in Russia, or elevated prevalence of depressive states among HP. We propose interventions aiming to destigmatize mental disorders by targeting particular subgroups of vulnerable patients and also certain representatives of HP community.