Relapse of depression during pregnancy following antidepressant discontinuation: a preliminary prospective study

Summary. Objective: Pregnancy has frequently been referred to as a time of emotional well-being for patients. However, systematic data about the risk for relapse of depression during pregnancy are sparse.Method: We completed a longitudinal cohort study of thirty-two (N=32) women with histories of depression who were euthymic at conception and who either discontinued or attempted to discontinue antidepressant therapy proximate to conception. Subjects were prospectively followed across pregnancy once per trimester using structured clinical interviews. Rates of relapse and time to relapse were examined. Factors distinguishing the population with respect to risk for relapse including demographic characteristics and illness history were also examined.Results: Seventy-five percent (N=24) of patients relapsed during pregnancy. The majority of relapses (79%, N=19) occurred in the first trimester, and relapse was more prevalent in women with histories of more chronic depression.Conclusions: Pregnancy is not protective with respect to risk for relapse of depression. Careful treatment planning is necessary for those women on antidepressants who plan to conceive or who become pregnant.     

Group interpersonal psychotherapy for postnatal depression: a pilot study

Summary We conducted a pilot study to assess the potential effectiveness of group interpersonal psychotherapy (IPT-G) as a treatment for postnatal depression (PND). The study was also established to test a treatment manual for IPT-G, assess the acceptability of this format for participants and test a recruitment strategy for a randomised controlled trial. 18 mothers diagnosed with PND participated in 2 individual session and 8 sessions of group IPT. A two-hour psychoeducational session was also held for the partners of the participants. Measures of depressive symptomatology and social adjustment were administered by an independent clinician at baseline, 4 weeks, 8 weeks and 3 months post treatment. Patient satisfaction with the treatment was also evaluated. Severity scores on the BDI, EPDS and the HDRS decreased from pre- to post-treatment. This was maintained at three months follow up. No overall improvement in the Social Adjustment Scale-Self Report was noted, although there was improvement in their relationship with their significant other. The results confirm previous work that IPT-G may improve symptom severity for women suffering from postnatal depression. Limitations included the use of antidepressant therapy by 67% of subjects and the lack of a control group. There is a need for further randomised controlled trials of IPT-G with larger sample sizes to establish its effectiveness as treatment for PND. An erratum to this article is available at .     

Psychotherapy alone versus collaborative psychotherapy and psychiatric care in the treatment of depression and anxiety in patients with cancer: A naturalistic,observational study

Objective

At present, there is a paucity of naturalistic studies directly comparing the effectiveness of psychotherapy alone versus collaborative psychotherapy and psychiatric care in the management of depression and anxiety in patients with cancer. This study tested the hypothesis that collaborative psychiatric and psychological care would lead to greater reductions in depression and anxiety symptoms in patients with cancer compared with psychotherapy alone.

Methods

We analyzed treatment outcomes of 433 adult patients with cancer, of which 252 patients received psychotherapy alone and 181 patients received collaborative psychotherapy and psychiatric care. Longitudinal changes in depressive (i.e., PHQ-9) and anxiety symptoms (GAD-7) were examined between groups using latent growth curve modeling.

Results

After controlling for treatment length and psychotherapy provider effects, results indicated collaborative care was more effective than psychotherapy alone for depressive symptoms (γ₁₂ = −0.13, p = 0.037). The simple slope for collaborative care was −0.25 (p = 0.022) and the simple slope for psychotherapy alone was −0.13 (p = 0.006), suggesting collaborative care resulted in greater reductions in depressive symptoms compared with psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and collaborative psychotherapy and psychiatric care in reducing anxiety symptoms (γ₁₂ = −0.08, p = 0.158).

Conclusions

Collaborative psychotherapy and psychiatric care may individually address unique aspects of mental health conditions in patients with cancer, namely depressive symptoms. Mental healthcare efforts may benefit from implementing collaborative care models where patients receive psychiatric services and psychotherapy to effectively address depressive symptoms in the treatment of this patient population.     

Role of the peripheral adrenergic component in effect of antidepressant on experimental behavioral depression in cats

Institute of Pharmacology, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR A. V. Val'dman,) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 110, No. 12, pp. 620–623, December, 1990.     

An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression

Background

Chronic major depressive disorder and dysthymia are associated with a high burden and substantial care costs. New and more effective treatments are required. This is the first randomized controlled trial designed to evaluate the effectiveness of Body Psychotherapy (BPT) in patients with chronic depression.

Methods

Patients with chronic depressive syndromes (more than 2 years symptomatic) and a total score of ≥20 on the Hamilton Rating Scale for Depression (HAMD) were randomly allocated to either immediate BPT or a waiting group which received BPT 12 weeks later. BPT was manualized, delivered in small groups in 20 sessions over a 10 weeks period, and provided in addition to treatment as usual. In an intention to treat analysis, primary outcome were depressive symptoms at the end of treatment adjusted for baseline symptom levels. Secondary outcomes were self-esteem and subjective quality of life.

Results

Thirty-one patients were included and twenty-one received the intervention. At the end of treatment patients in the immediate BPT group had significantly lower depressive symptom scores than the waiting group (mean difference 8.7, 95% confidence interval 1.0–16.7). Secondary outcomes did not show statistically significant differences. When the scores of the waiting group before and after BPT (as offered after the waiting period) were also considered in the analysis, the differences with the initial waiting group remained significant.

Conclusions

The results suggest that BPT may be an effective treatment option for patients with chronic depression. Difficulty recruiting and subsequent attrition was one of the limitations, but the findings merit further trials with larger samples and process studies to identify the precise therapeutic mechanisms.     

家庭病房患者伴发抑郁症65例临床分析

为了解家庭病房患者抑郁状态情况，我们采用ZUNG编制的抑郁自评量表（S．D．S）对65例患者进行调查，发现抑郁症32例，占被调查人数的49％，其中轻度抑郁症17例、中度抑郁症9例、重反抑郁症6例。提示家庭医生应提高对抑郁症的认识，在治疗患者躯体疾病的过程中友现抑郁症积极治疗，以利躯体疾病的早日康复。     

Association between symptomatic profile and remission following antidepressant treatment in unipolar major depression

Background

To evaluate, in patients affected by an acute major depressive episode, what predictive value certain baseline psychopathological characteristics have with regard to expected therapeutic remission following biological antidepressant treatment (pharmacological/electroconvulsive; non-psychological).

Methods

Six predefined psychopathological characteristics in acute major depressive episode were evaluated using a logistic regression model through a protocolised antidepressant treatment to assess their predictive value with regard to expected remission rate.

Results

The final study sample consisted of 129 subjects affected by an acute major depressive episode. From the baseline evaluation of the anguish/restlessness, reduced emotional reactivity, reduced attention, reduced motor response, feeling of worthlessness, and mood characteristics items, it was possible to correctly classify 88.1% of the sample as remitter/non-remitter with sensitivity of 0.77 and specificity of 0.96. Addition of the 17-item HRSD baseline variable to the regression model increased the capacity for correct classification of the baseline sample by only 0.09%.

Limitations

Protocolised antidepressant treatment was used. The results of this study may not be generalisable to pharmacological treatments not included in this protocol.

Conclusions

The results of this study suggest that certain baseline psychopathological characteristics (and perhaps other clinical variables too) of the acute major depressive episode may be of great use in establishing patient subgroups according to expected clinical remission to the administration of biological antidepressant treatment. This could have considerable consequences for individualised therapeutic decision-making and for future researches (clinical trials included).     

Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis

It is not well-known whether self-report measures and clinician-rated instruments for depression result in comparable outcomes in research on psychotherapy. We conducted a meta-analysis in which randomized controlled trials were included examining the effects of psychotherapy for adult depression. Only studies were included in which both a self-report and a clinician-rated instrument were used. We calculated the effect size (Hedges' g) based on the self-report measures, the effect size based on the clinician-rated instruments, and the difference between these two effect sizes (Δg). A total of 48 studies including a total of 2462 participants was included in the meta-analysis. The differential effect size was Δg = 0.20 (95% CI: 0.10–0.30), indicating that clinician-rated instruments resulted in a significantly higher effect size than self-report instruments from the same studies. When we limited the effect size analysis to those studies comparing the HRSD with the BDI, the differential effect was somewhat smaller, but still statistically significant (Δg = 0.15; 95% CI: 0.03–0.27). This meta-analysis has made it clear that clinician-rated and self-report measures of improvement following psychotherapy for depression are not equivalent. Different symptoms may be more suitable for self-report or ratings by clinicians and in clinical trials it is probably best to include both.     

Hypothalamus-pituitary-adrenal modifications consequent to chronic stress exposure in an experimental model of depression in rats

The modifications in the hypothalamus-pituitary-adrenal (HPA) axis function induced by repeated unavoidable stress exposure, according to a standardized procedure used for inducing an experimental model of depression, were studied. Rats exposed to this procedure show hyporeactivity to both pleasurable and aversive stimuli and this condition is antagonized by the repeated administration of classical antidepressant drugs. We also studied whether imipramine administration during stress exposure would interfere with the possible modifications in the HPA axis. Rats were exposed to a 4-week stress procedure with and without imipramine treatment and then tested for escape, as compared with non-stressed control animals. Twenty-four hours later all rats were bled through a tail nick for plasma corticosterone measurement before and after dexamethasone (10 microg/kg) or corticotropin-releasing hormone (CRH, 1 microg/kg) administration. Rats were then killed, adrenals and thymus weighed, brain areas dissected out and frozen for glucocorticoid receptors (GRs) and corticotropin-releasing hormone receptor 1 (CRHR1) immunoblotting and for the assessment of hypothalamic corticotropin-releasing hormone levels. RESULTS: Rats exposed to a 4-week unavoidable stress showed escape deficit and their basal plasma corticosterone levels were higher than those of control animals. Moreover, they had decreased response to dexamethasone administration, adrenal hypertrophy, and decreased GR expression in the hippocampus, hypothalamus, medial prefrontal cortex and pituitary. No significant modifications in CRHR1 expression were observed in the pituitary nor in different discrete brain areas. CRH levels in the hypothalamus and the plasma corticosterone response to CRH administration were found to be higher in stressed rats than in controls. Imipramine treatment offset all the behavioral and neurochemical stress-induced modifications. In conclusion, the present results strengthen the assumption that the escape/avoidance behavioral deficit induced by inescapable stress exposure is accompanied by steadily increased HPA activity, and that imipramine effect is strongly related to a normalization of HPA axis activity.     

Lymphocyte subset differences in patients with chronic fatigue syndrome, multiple sclerosis and major depression

Chronic fatigue syndrome (CFS) is a heterogeneous disorder of unknown aetiology characterized by debilitating fatigue, along with other symptoms, for at least 6 months. Many studies demonstrate probable involvement of the central and autonomic nervous system, as well as a state of generalized immune activation and selective immune dysfunction in patients with CFS. The aim of this study was to compare the lymphocyte subsets of patients with chronic fatigue syndrome to those of patients with major depression and multiple sclerosis as well as those of healthy control subjects. No differences were found in total numbers of T cells, B cells or natural killer (NK) cells. However, differences were found in T, B and NK cell subsets. Patients with major depression had significantly fewer resting T (CD3(+)/CD25(-)) cells than the other groups. Patients with major depression also had significantly more CD20(+)/CD5(+) B cells, a subset associated with the production of autoantibodies. Compared to patients with multiple sclerosis, patients with CFS had greater numbers of CD16(+)/CD3(-) NK cells. Further study will be required to determine whether these alterations in lymphocyte subsets are directly involved in the pathophysiology of these disorders, or are secondary effects of the causal agent(s).     

慢性应激抑郁状态对大鼠海马神经元再生的影响

目的:探讨慢性应激性刺激引起的抑郁状态对大鼠海马神经元再生的影响。方法:建立大鼠慢性应激性抑郁症模型,通过开场实验和蔗糖饮水实验观察大鼠行为学变化;取大鼠脑冰冻切片行Doublecortin(DCX)免疫荧光检测海马新生神经元。结果:慢性应激抑郁模型大鼠开场实验水平运动得分和垂直运动得分降低,蔗糖偏嗜度降低,且体重明显减轻;免疫荧光结果显示慢性应激抑郁模型大鼠海马齿状回颗粒下层(subgranularzone SGZ)DCX阳性细胞减少。结论:慢性应激性刺激引起的抑郁状态下大鼠海马神经元再生能力减弱,提示海马神经元再生的损害可能参与了抑郁症的病理过程。     

Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI‐D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty‐eight women with a DSM‐IV diagnosis of major depression or dysthymia were allocated to a 10‐session IPPI‐D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI‐D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message

• This study sheds light on the client satisfaction and adherence to a positive intervention.
• For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization
• Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations

     

慢性社交挫败小鼠抑郁模型的代谢组分析

目的:通过代谢组学检测和分析,比较抑郁小鼠和对照小鼠前额叶皮质代谢物质的差异,探索脑代谢物与抑郁症之间的相互关系。方法:建立小鼠慢性社交挫败应激(CSDS)模型,并通过一系列行为学实验验证该动物模型。采用超高效液相四级杆飞行时间串联质谱非靶向代谢组学的分析技术检测具有抑郁表型的小鼠与对照组小鼠前额叶皮质脑区的代谢物质。并通过主成分分析(PCA)、偏最小二乘法判别分析(PLS-DA)及正交偏最小二乘法判别分析(OPLS-DA)等统计学方法来筛选并鉴定具有明显差异的代谢物质。结果:与正常组相比,模型组小鼠出现明显的抑郁样症状。在脑代谢物方面,与正常组相比,模型组前额叶皮质中有26种代谢物的含量发生了显著改变,其中11种代谢产物含量增高,15种代谢产物降低。通路分析结果中特别值得注意的有两个代谢物。其一是3-磷酸甘油乙醇胺,它是抑郁症相关的内源性大麻素系统中的成分之一,其含量增高。其二是色氨酸,它是抑郁症相关的5-HT合成相关代谢通路上的成分之一,其含量降低。结论:慢性抑郁症小鼠模型前额叶皮质的脑代谢产物发生了改变,这些改变有望作为一种代谢指标,以帮助诊断抑郁症和研发针对性的治疗方法。