Gabapentin augmentation therapy in bipolar depression

Background:  Gabapentin (GBP) may be useful in bipolar disorders, including as adjunctive therapy for bipolar depression, although controlled studies suggest inefficacy as primary treatment for mania or treatment-resistant rapid cycling.
Methods:  We performed a 12-week trial of open GBP (mean dose 1725 mg/day) added to stable doses of mood stabilizers or atypical antipsychotics in 22 (10 women, mean age 38.4 years) depressed [28-item Hamilton Depression Rating Scale (HDRS) >18] bipolar (10 bipolar I, 12 bipolar II) disorder outpatients. Mean illness duration was 18.6 years; current depressive episode duration was 18.0 weeks. Prospective 28-item HDRS, Young Mania Rating Scale (YMRS) and Clinical Global Impression – Severity (CGI-S) ratings were obtained.
Results:  Overall, HDRS ratings decreased 53% from 32.5 ± 7.7 at baseline to 16.5 ± 12.8 at week 12 (p < 0.0001). Twelve of 22 (55%) patients had moderate to marked improvement (HDRS decrease=50%) with HDRS decreasing 78% from 27.9 ± 6.2 to 6.2 ± 4.5 (p < 0.0001). Eight of 22 (36%) patients remitted (HDRS≥8). In non-responders, HDRS decreased from 38.0 ± 5.4 to 28.9 ± 6.7 (p=0.005). Ten of 13 (77%) mild to moderately depressed (baseline HDRS >18 and <35) patients responded, while only two of nine patients (22%) with severe depression (HDRS ≥ 35) responded (p < 0.03). Both groups, however, had similar, statistically significant HDRS decreases. GBP was well tolerated.
Conclusion:  Open adjunctive GBP was effective and well tolerated in patients with mild to moderate bipolar depression. This open pilot study must be viewed with caution, and randomized controlled studies are warranted.     

The Promotion of Sustainable Diets in the Healthcare System and Implications for Health Professionals: A Scoping Review

The impacts of the current global food system are already visible in the environment and in the health of the population. The promotion of sustainable diets is key to counter the negative consequences. The healthcare system could be a powerful tool to educate patients by guiding their diets towards sustainability. This study aimed to assess the size and scope of the available literature regarding the promotion of sustainable diets in the healthcare system and to obtain a reliable approximation of the processes and roles related to sustainable diet promotion within healthcare systems. A scoping review where online databases were used to identify English written scientific and grey literature published between 2000–2019 was carried out. The analytical–synthetic approach was used for data charting. Twelve studies were included that were published between 2007–2020. The data highlight education, community and clinical health services, community engagement and policy advocacy, and governance as main action areas along with two transversal aspects, social support, and gender. A systemic approach to the food system is emphasized. Evidence suggests that health professionals have the potential to drive a paradigm shift in food–health environments. Currently, however, their role and potential impact is underestimated within healthcare systems. This review has identified a framework with key areas where processes need to be developed to guarantee sustainable diet promotion in healthcare services.