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acceptability of 21 #antidepressant drugs for the acute treatment of adults with major #depressive disorder: a systematic review and network meta-analysis

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext


In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low.

Interpretation
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.

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The gut #microbiome regulates the increases in #depressive-type behaviors and in inflammatory processes in the ventral hippocampus of stress vulnerable rats

https://www.nature.com/articles/s41380-019-0380-x

Chronic exposure to stress is associated with increased incidence of depression, generalized anxiety, and PTSD. However, stress induces vulnerability to such disorders only in a sub-population of individuals, as others remain resilient. Inflammation has emerged as a putative mechanism for promoting stress vulnerability.

Because gut microbiota are important activators of inflammatory substances, we assessed the role of the gut microbiome in mediating vulnerability to repeated social defeat stress. We analyzed the fecal microbiome of control, SL/vulnerable, and LL/resilient rats using shotgun metagenome sequencing and observed increased expression of immune-modulating microbiota, such as Clostridia, in SL/vulnerable rats

..Taken together, the results suggest the gut microbiome contributes to the depression-like behavior and inflammatory processes in the vHPC of stress vulnerable individuals.

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#Depressive Symptoms and Onset of Functional #Disability Over 2 Years: A Prospective Cohort Study

https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15801

scales, Katz Index of Independence in Activities of Daily Living (ADLs), the Lawton Instrumental Activities of Daily Living (IADLs) scale, and the Rosow and Breslau mobility scale.

.. After adjusting for covariates, the odds of ADL disability onset (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02‐1.11), IADL disability onset (OR = 1.05; 95% CI = 1.01‐1.09), and mobility disability onset (OR = 1.05; 95% CI = 1.01‐1.09) were consistently higher in US Chinese older adults with higher levels of depressive symptoms than their less‐depressed counterparts. Other significant risk factors included older age and more chronic physical conditions.

CONCLUSION
Study findings underscore a significant relationship between depressive symptoms and onset of functional disability. Screening and, subsequently, treating depressive symptoms have the potential to reduce disability among US Chinese older adults. Culturally relevant depressive symptom screening may help identify Chinese older adults who are at greater risks for the development of functional disability

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Association of Obstructive Sleep #Apnea With the Risk of Affective Disorders

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2749521

..In a subgroup analysis, the adjusted HRs for patients with OSA who developed #depressive and #anxiety disorders were 2.90 (95% CI, 1.98–4.24) and 1.75 (95% CI, 1.26–2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]).

Conclusions and Relevance This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.

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Association of Use of Oral #Contraceptives With #Depressive Symptoms Among #Adolescents and Young Women

.. adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (β coefficient for interaction with age, –0.021; 95% CI, –0.038 to –0.005; P = .0096).

Adolescent contraceptive users particularly reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers.

Conclusions and Relevance Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2751923

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Efficacy and safety of #anti-inflammatory agents for the treatment of major #depressive disorder: a systematic review and meta-analysis of randomised controlled trials

..Four studies explored the antidepressant effects of NSAIDs in addition to traditional antidepressants. In all four studies, celecoxib was added at the same dose (400 mg/day). Traditional antidepressants used were sertraline, fluoxetine and reboxetine.

We combined these studies for a subgroup meta-analysis, finding that antidepressants combined with celecoxib were better than antidepressants alone, leading to a larger reduction in depressive score (four RCTs, SMD −0.76, 95% CI −1.14 to −0.39, p<0.0001). Heterogeneity among studies was insignificant

..Five trials focused on women with MDD. Of these, one assessed the effect of celecoxib added to sertraline, while the other four examined the antidepressive effect of omege-3 FA as monotherapy. Combining the five studies, no difference in score changes was found between groups (SMD −0.49, 95% CI −1.01 to 0.03, p=0.06), with moderate heterogeneity detected among studies

Conclusion
Our systematic review and meta-analysis suggests that anti-inflammatory agents exert an antidepressant effect in the treatment of MDD and were generally safe with rates of adverse effects similar to those of placebo. Adjunctive treatment shows a more remarkable effect with NSAIDs, omega-3 FAs, statins and minocyclines showing significant antidepressant effects for MDD.

Anti-inflammatory agents show promising effects for MDD. However, owing to the chronic course of MDD, quality of life and adverse effects should be further investigated in high-quality randomised clinical trials with long-term follow-up.

https://jnnp.bmj.com/content/early/2019/08/29/jnnp-2019-320912.full

#Depressive symptoms and objectively measured physical activity and #sedentary behaviour throughout adolescence: a prospective cohort study

..Higher depression scores at 18 years were associated with a 60 min/day increase in sedentary behaviour at 12 years (incidence rate ratio [IRR] 1·111 [95% CI 1·051–1·176]), 14 years (1·080 [1·012–1·152]), and 16 years of age (1·107 [1·015–1·208]). Depression scores at 18 years were lower for every additional 60 min/day of light activity at 12 years (0·904 [0·850–0·961]), 14 years (0·922 [0·857–0·992]), and 16 years of age (0·889 [0·809–0·974]). Group-based trajectory modelling across 12–16 years of age identified three latent subgroups of sedentary behaviour and activity levels.

Depression scores were higher in those with persistently high (IRR 1·282 [95% CI 1·061–1·548]) and persistently average (1·249 [1·078–1·446]) sedentary behaviour compared with those with persistently low sedentary behaviour, and were lower in those with persistently high levels of light activity (0·804 [0·652–0·990]) compared with those with persistently low levels of light activity. Moderate-to-vigorous physical activity (per 15 min/day increase) at age 12 years (0·910 [0·857–0·966]) and total physical activity (per 100 CPM increase) at ages 12 years (0·941 [0·910–0·972]) and 14 years (0·965 [0·932–0·999]), were negatively associated with depressive symptoms.

Interpretation
Sedentary behaviour displaces light activity throughout adolescence, and is associated with a greater risk of depressive symptoms at 18 years of age. Increasing light activity and decreasing sedentary behaviour during adolescence could be an important target for public health interventions aimed at reducing the prevalence of depression.

https://bit.ly/2tVPMda

Thalamic Gamma Aminobutyric Acid Level Changes in Major #Depressive Disorder After a 12-Week Iyengar Yoga and Coherent #Breathing Intervention

To determine if a 12-week yoga intervention (YI) was associated with increased gamma aminobutyric acid (GABA) levels and decreased depressive symptoms in participants with major depressive disorder (MDD).

Subjects were randomized to a high-dose group (HDG) of three YIs a week and a low-dose group (LDG) of two YIs a week. 

..BDI-II scores improved significantly in both groups. GABA levels from Scan-1 to Scan-3 and from Scan-2 to Scan-3 were significantly increased in the LDG (n = 15) and showed a trend in the total cohort. Post hoc, participants were divided into two groups based on having an increase in GABA levels at Scan-2. Increases in Scan-2 GABA levels were observed in participants whose mean time between their last YI and Scan-2 was 3.93 ± 2.92 standard deviation (SD) days, but not in those whose mean time between their last YI and Scan-2 was 7.83 ± 6.88 SD.

Conclusions: This study tentatively supports the hypothesis that one of the mechanisms through which yoga improves mood is by increasing the activity of the GABA system. The observed increase in GABA levels following a YI that was no longer observed 8 days after a YI suggests that the associated increase in GABA after a YI is time limited such that at least one YI a week may be necessary to maintain the elevated GABA levels.

https://bit.ly/31TE2UR

Effect of Long-term Vitamin #D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant #Depressive Symptoms and on Change in Mood Scores A Randomized Clinical Trial
https://2medical.news/2020/08/10/effect-of-long-term-vitamin-d3-supplementation-vs-placebo-on-risk-of-depression-or-clinically-relevant-depressive-symptoms-and-on-change-in-mood-scores-a-randomized-clinical-trial/

Low levels of 25-hydroxyvitamin D have been associated with higher risk for depression later in life, but there have been few long-term, high-dose large-scale trials.. Randomized assignment in a 2 × 2 factorial design to vitamin D3 (2000 IU/d of cholecalciferol) and fish oil or placebo; 9181 were randomized to vitamin D3 and 9172 were randomized to matching placebo.. Among the 18 353 randomized participants (mean age, 67.5 …

Increased rates of #eating disorders and their symptoms in women with major #depressive disorder and #anxiety disorders
https://2medical.news/2020/09/03/increased-rates-of-eating-disorders-and-their-symptoms-in-women-with-major-depressive-disorder-and-anxiety-disorders/

Individuals with eating disorders (EDs) have increased rates of major depressive disorder (MDD) and anxiety disorders. Yet, few studies have investigated rates of EDs and their symptoms in individuals presenting with MDD/anxiety disorders. Identifying potential disordered eating in people with MDD/anxiety disorders is important because even subclinical disordered eating is associated with reduced quality of life, and undiagnosed eating pathology may hinder treatment progress for …

Effects of #Psilocybin-Assisted Therapy on Major #Depressive Disorder
https://2medical.news/2020/11/08/effects-of-psilocybin-assisted-therapy-on-major-depressive-disorder/

Major depressive disorder (MDD) is a substantial public health burden, but current treatments have limited effectiveness and adherence. Recent evidence suggests that 1 or 2 administrations of psilocybin with psychological support produces antidepressant effects in patients with cancer and in those with treatment-resistant depression.. ..Two psilocybin sessions (session 1: 20 mg/70 kg; session 2: 30 mg/70 kg) were given (administered in opaque gelatin capsules with …