Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

World Psychiatry, Год журнала: 2023, Номер 22(3), С. 394 - 412

Опубликована: Сен. 15, 2023

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.

Язык: Английский

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The antidepressant actions of ketamine and its enantiomers

Pharmacology & Therapeutics, Год журнала: 2023, Номер 246, С. 108431 - 108431

Опубликована: Май 4, 2023

Язык: Английский

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Robust antiviral activity of commonly prescribed antidepressants against emerging coronaviruses: in vitro and in silico drug repurposing studies

Scientific Reports, Год журнала: 2022, Номер 12(1)

Опубликована: Июль 28, 2022

Abstract During the current coronavirus disease 2019 (COVID-19) pandemic, symptoms of depression are commonly documented among both symptomatic and asymptomatic quarantined COVID-19 patients. Despite that many FDA-approved drugs have been showed anti-SARS-CoV-2 activity in vitro remarkable efficacy against clinical trials, no pharmaceutical products yet declared to be fully effective for treating COVID-19. Antidepressants comprise five major drug classes treatment depression, neuralgia, migraine prophylaxis, eating disorders which frequently reported Herein, eight prescribed antidepressants on inhibition SARS-CoV-2 MERS-CoV was assessed. Additionally, anti-MERS-CoV activities were evaluated. Furthermore, molecular docking studies performed these spike (S) main protease (M pro ) pockets MERS-CoV. Results Amitriptyline, Imipramine, Paroxetine, Sertraline had potential anti-viral activities. Our findings suggested aforementioned deserve more vivo targeting especially those patients suffering from depression.

Язык: Английский

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Ketamine and serotonergic psychedelics: An update on the mechanisms and biosignatures underlying rapid-acting antidepressant treatment

Neuropharmacology, Год журнала: 2023, Номер 226, С. 109422 - 109422

Опубликована: Янв. 13, 2023

Язык: Английский

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Predicting outcome with Intranasal Esketamine treatment: A machine-learning, three-month study in Treatment-Resistant Depression (ESK-LEARNING)

Psychiatry Research, Год журнала: 2023, Номер 327, С. 115378 - 115378

Опубликована: Июль 29, 2023

Treatment-resistant depression (TRD) represents a severe clinical condition with high social and economic costs. Esketamine Nasal Spray (ESK-NS) has recently been approved for TRD by EMA FDA, but data about predictors of response are still lacking. Thus, tool that can predict the individual patients' probability to ESK-NS is needed. This study investigates sociodemographic features predicting responses in patients using machine learning techniques. In retrospective, multicentric, real-world involving 149 subjects, psychometric (Montgomery-Asberg-Depression-Rating-Scale/MADRS, Brief-Psychiatric-Rating-Scale/BPRS, Hamilton-Anxiety-Rating-Scale/HAM-A, Hamilton-Depression-Rating-Scale/HAMD-17) were collected at baseline one month/T1 three months/T2 post-treatment initiation. We trained different random forest classifiers, able accuracies 68.53% T1 66.26% T2 remission 68.60% accuracy. Features like anhedonia, anxious distress, mixed symptoms as well bipolarity found positively remission. At same time, benzodiazepine usage severity linked delayed responses. Despite some limitations (i.e., retrospective study, lack biomarkers, correct interrater-reliability across centers), these findings suggest potential personalized intervention TRD.

Язык: Английский

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Effects of anhedonia on health-related quality of life and functional outcomes in major depressive disorder: A systematic review and meta-analysis

Journal of Affective Disorders, Год журнала: 2024, Номер 356, С. 684 - 698

Опубликована: Апрель 23, 2024

Язык: Английский

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Positive affect and reward processing in the treatment of depression, anxiety and trauma

Nature Reviews Psychology, Год журнала: 2024, Номер unknown

Опубликована: Сен. 16, 2024

Язык: Английский

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Changes in white matter microstructure following serial ketamine infusions in treatment resistant depression

Human Brain Mapping, Год журнала: 2023, Номер 44(6), С. 2395 - 2406

Опубликована: Янв. 30, 2023

Abstract Ketamine produces fast‐acting antidepressant effects in treatment resistant depression (TRD). Though prior studies report ketamine‐related changes brain activity TRD, understanding of ketamine's effect on white matter (WM) microstructure remains limited. We thus sought to examine WM neuroplasticity and associated clinical improvements following serial ketamine infusion (SKI) TRD. TRD patients ( N = 57, 49.12% female, mean age: 39.9) received four intravenous infusions (0.5 mg/kg) 2–3 days apart. Diffusion‐weighted scans assessments (Hamilton Depression Rating Scale [HDRS‐17]; Snaith Hamilton Pleasure [SHAPS]) were collected at baseline 24‐h after SKI. measures including the neurite density index (NDI) orientation dispersion (ODI) from imaging (NODDI) model, fractional anisotropy (FA) diffusion tensor model compared voxelwise pre‐ post‐SKI using Tract‐Based Spatial Statistics workflows align tracts across subjects/time. Correlations between change metrics subsequently assessed. Following SKI, showed significant HDRS‐17 p ‐value 1.8 E‐17) SHAPS 1.97 E‐10). NDI significantly decreased occipitotemporal pathways < .05, FWER/TFCE corrected). ΔSHAPS correlated with ΔNDI left internal capsule superior longitudinal fasciculus r −0.614, 6.24E‐09). No ODI or FA observed. SKI leads microstructural features neurites within tracts, connecting basal ganglia, thalamus, cortex relate anhedonia. NODDI may be more sensitive for detecting ketamine‐induced than DTI.

Язык: Английский

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Annual Research Review: Puberty and the development of anhedonia – considering childhood adversity and inflammation

Journal of Child Psychology and Psychiatry, Год журнала: 2024, Номер 65(4), С. 459 - 480

Опубликована: Фев. 23, 2024

Anhedonia, or diminished pleasure and motivation, is a symptom of severe mental illness (e.g., depressive disorder, bipolar schizophrenia) that emerges during adolescence. Anhedonia pernicious related to social impairments, treatment resistance, suicide. As the mechanisms anhedonia are postulated include frontostriatal circuitry dopamine neuromodulatory system, development plasticity these systems vulnerable period adolescence, as well their sensitivity pubertal hormones, suggest maturation could play role in anhedonia. This review takes developmental perspective, considering possibility context adolescent development, with childhood adversity chronic inflammation influencing neural reward accelerate anhedonia's progression. Here, we relevant extant literature on components this model directions for future research.

Язык: Английский

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Evaluating Anhedonia as a risk factor in suicidality: A meta-analysis

Journal of Psychiatric Research, Год журнала: 2022, Номер 158, С. 209 - 215

Опубликована: Дек. 20, 2022

Язык: Английский

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