Patients with depression often suffer from accompanying symptoms that may influence the choice of second-generation antidepressant (SGA) therapy.

To determine the comparative effectiveness of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for treating common accompanying symptoms of depression.

We searched MEDLINE®, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and identified unpublished research. Two persons independently reviewed abstracts and full-text articles and abstracted data. We included randomized, head-to-head trials of SGAs (>6 weeks, N > 40). We graded the strength of the evidence for each symptom as high, moderate, low, or insufficient using the US Agency for Healthcare Research and Quality (AHRQ) approach.

We located 22 head-to-head trials for anxiety; insomnia; pain; melancholia; psychomotor change; or somatization. for the majority of symptoms the strength of the evidence was low or insufficient. for treating anxiety and treating depression in patients with accompanying anxiety, moderate evidence suggests there is no difference between SGAs. Likewise, for patients with depression and pain, moderate evidence suggests there is no difference between paroxetine and duloxetine for reducing the pain.

Evidence guiding the selection of an SGA based on accompanying symptoms of depression is limited. Very few trials were designed and adequately powered to answer questions about accompanying symptoms; analyses were generally of subgroups in larger depression trials. Where evidence is available, it suggests no difference between SGAs in their efficacy for treating the depressive episode or the accompanying symptom.

People with particular medical illnesses are at an increased risk of depression. Similarly, other psychiatric or behavioral illnesses increase the risk of depressive disorders. there is a growing interest in the comparative benefits and harms of second-generation antidepressants for treating depression with co-occurring illness.

To compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of depressive syndromes in certain demographic populations (e.g., older adults) and in subgroups with comorbidities.

We updated a comparative effectiveness review (CER) published in 2007 by the Agency for Healthcare Research and Quality searching MEDLINE, Embase, the Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias. in addition, investigators graded the strength of the body of evidence.

Evidence on subgroups is sparse. Head-to-head RCTs often exclude subgroups. We found no studies designed to compare a particular subgroup with the general population. in older adults, efficacy does not differ substantially among second-generation antidepressants; however, there may be some differences in adverse events. We found no head-to-head trials comparing efficacy and harms in different race or ethnic groups. Comparative evidence on comorbidities was limited to a subgroup analysis of depressed adults with generalized anxiety disorder.

There is a great need for research focusing directly on the efficacy and safety of second-generation antidepressants in these more vulnerable populations.

Physical exercise has shown promising results as an adjuvant therapy for depression. However, most studies rely on self-reported measures, which are subject to bias.

To assess, using accelerometer data, compliance to a moderate intensity 12 week exercise program, exercise patterns and relationship between exercise dose and response to treatment, in a population sample of patients with treatment-resistant MDD.

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. All participants wore an ActiGraph® GT1M LLC accelerometer during the 12 weeks. Assessed parameters Moderate plus vigorous physical activity (MVPA), HAMD17, BDI, GAF, CGI-S.

The exercise group showed better depression and functional parameters at the end of the study compared to the control group (lower HAMD17, BDI, CGI-S; higher GAF, p < 0.05). Compliance was 97% based on accelerometer data and 91% based on self-reports. Participants showed preference for exercising on weekdays and on specific periods of the day.

Although not statistically significant, there was a trend for increasing MVPA from no response to response and remission. MVPA showed significant favourable correlations with all depression and functioning parameters.

Future implementation of effective exercise augmentation therapy programs should consider exercise dose and objective measures that will allow the quantification of that dose.

Some studies have suggested that the current global financial and economic crisis is having a negative impact in the population mental health. However, data on previously remitted Major Depressive Disorder (MDD) patients is not available.

To assess depression status in a population sample of remitted MDD patients after the onset of the current global financial crisis.

Study design Retrospective, observational. Population sample 80 patients (40 men, 40 women) attending a private psychiatric clinic in Porto, Portugal, between January 2007 and September 2011, were reviewed retrospectively. Inclusion criteria were diagnosis of moderate to severe MDD in 2007, remission in 2008 and change in employment status or income between 2009 and 2011. Patients were divided in two groups: Group 1, who have lost their job or >50% of income between 2009 and 2011, and Group 2, who remained employed or with >50% of income. Assessed parameters HAMD17 and BDI.

Between 2009 and 2011, 50% of men and 30% of women from group 1 and 8% of men and 12% of women from group 2 relapsed. 40% of men and 10% of women from group 1 relapsed to a more severe MDD when compared to 2007, while in group 2 there was no change in severity status within those who relapsed.

Results suggest that the global financial crisis, when leading to unemployment or loss of income, is responsible for an overall 30% increase of MDD relapse. Men seem to be more vulnerable than women when facing economic adversity.

Depression is considered as one of the most important etiological academic failure in educational systems, that induced decrease social, professional and educational performance, therefore, recognize this problem is necessary for suppression educational failure in students and increase social position in the academic period and increase mental health in educational society. the aim of this study was determine prevalence depression in the medical students also the relationship with educational failure in the jahrom university medical science.

This cross- sectional study was performed on all students (150), this study had two groups students; successful and unsuccessful students. A Beck questionnaire as well as a questionnaire for personal data especially those related to depression were used, the collected data was statistically analyzed using SPSS.

45.5 percent students had mild to severe depression and there was relationship between depression and academic achievement (po/oo4), 75 percent successful students and 39.4 percent unsuccessful students had mild to moderate depression. there was no significant relationship between depression and sex, academic major, occupation and level of parental education.

According to the findings, there are high prevalence sense of depression especially between unsuccessful students therefore, the follow up of mental health and personality and activation of mental consultaion centers is necessary.

Depression is the most common psychological problem in patients with End-Stage Renal Disease (ESRD). the present study was conducted to determine the rate of depression in chronic hemodialysis.

56 patients (34 men, 22 women) who had undergone hemodialysis were selected as the subjects of the study by convenient sampling. A demographic questionnaire and Beck Depression Inventory were used to collect data. Statistical analyses were preformed by SPSS.

In this study, 85% of patients had some degree of depression, of which mild depression 34.5%, 30.9% and 18.2% moderate depression to severe depression, and 1.8 percent were suffering from very severe depression. These findings are also examined with the demographics of patients, e.g. age and sex, as well as the duration of dialysis they had undergone.

It seems the screening of hemodialysis Patients with Beck Depression inventory. I followed by referring the depressed patients to a psychiatrist for more evaluation is necessary so that at least some of the suffering, morbidity and mortality of the patients will be diminished.

To identify the efficacy of the treatment with Pregabalin in patients with chronic pain associated to comorbilidad with depression.

Descriptive study of a sample of patients with depression and chronic pain admitted in Clinica Doctor Cano (Salobrena- Granada, Spain) between January 2010 and January 2011, with data of the clinical histories: Age, sex, psychiatric and illness comorbidity, socio-demographic variables, and hospitalization.

All the patients received antidepressing treatment with an SSRIs (serotonin-specific reuptake inhibitor) in a time not superior to four weeks, associated with a benzodiazepine of low power (lorazepam). We added Pregabalin to an rising dose of 75–150 mg per day.

70% are women. We observe decrease of the perception of the pain in 75% of patients. the patients who answered better to the antidepressing treatment (valued with scale HAM-Depression) obtained better response with Pregabalin on the chronic pain.

It is important to determine the association between chronic pain and depression for to improve the efficacy of therapeutic approaches. Pregabalin can be useful in a a sample of patients with this comorbidity.

Despite the abundant research on impulsivity and that on depression, and despite several lines of clinical and research evidence pointing out the potential associations between the two phenomena, to date the idea that impulsivity is linked to depression is still seriously questioned.

1. (i) To argue that there is a body of research linking impulsivity and depression, and that this research is under-recognized largely due to the complex, multi-faceted nature of impulsivity, and its varied definitions and measurements used in different studies, resulting in mixed, irreconcilable findings.

2. (ii) To provide a possible theoretical integration of impulsivity in the context depression.

3. (iii) To validate this theoretical integration.

1. (i) Literature review of impulsivity.

2. (ii) Systematic review and synthesis of research on impulsivity and depression.

3. (iii) Development of a new measure of impulsivity based on outcomes from (i) and (ii); and validation of this new measure in both general and clinical populations.

1. (i) An integrated framework for impulsivity, suggesting three key types of impulsivity: rapid response, preference for immediate reinforcement, and underestimation of risk, is identified and adopted.

2. (ii) An operational definition of impulsivity as an action or a behavioural pattern that goes against one's desired goal is offered.

3. (iii) The Types of Impulsivity Scale, assessing the three key types of impulsivity concurrently, shows good predictive validity for depression.

Different types of impulsivity seem to be related to different stages of the depressive disorder. Clinical implications for the diagnosis, treatment and prevention of depression will be drawn accordingly.

Recent studies have shown that psychopathological rating by the Hamilton Depression Rating scale (HAMD) is well established and highly predictive for later response. in this study we aimed to find out if Clinical Global Impression (CGI) scale is suitable to guide antidepressive treatment under naturalistic conditions.

Inpatients with a major depressive disorder and treatment with citalopram were included and rated using in parallel the HAMD scale and the CGI scale weekly at baseline to day 35. According to CGI the sample has been divided in “CGI improver” (CGI = 2–4) and “CGI non-improver” (CGI = 5–6). Response was defined as HAMD sum score reduction by at least 50%.

55 patients were included. A HAMD score reduction of ≥24% on day 14 was highly predictive (p = 0.016) for both response and non-response on day 35. Among patients who improved on CGI scale at week two 33% became responder at week five vs 44% when improvement on HAMD scale was achieved. HAMD sum scores correlated well on the CGI scale (53–74%, p = 0.000). Patients who were “improved” according to CGI scale on day 14 exhibited less reduction on the HAMD scale on day 35 than patients who were “improved” according to HAMD (35% vs 46%, respectively). CGI rating on day 14 predicted response on day 35 with only 44% specificity (p = 0.255).

Our findings revealed that the CGI rating scale is not predictive for later response on day 35.

Psychotic depression (PD) is classified as a sybtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception that psychotic features in depression arise as a consequence of depressive severity.

To determine whether the severity of depression and psychosis correlate in accordance with the “severity-psychosis” hypothesis and to detect potential differences in clinical features of psychotic and non-psychotic depression (non-PD).

We aimed to answer the following questions:

1. Does the clinical profile differ between patients with PD and non-PD?

2. Is the severity of depression and psychosis correlated in patients with depression?

Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital between 2000 and 2010 due to a severe depressive episode.

A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p < 0.001), aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). the HoNOS scores on the two items “depression” and “hallucinations and delusions” were very weakly correlated (Spearman coefficient = 0.12).

The results suggest that the severity of depression is unlikely to be the key determinant for the development of psychosis and supports the hypothesis that the psychotic- and non-psychotic subtypes of depression are in fact distinct clinical syndromes.

The KIBRA rs17070145 “CC” and the CLSTN2 rs6439886 “TT” genotypes have been associated with poor episodic memory performance in healthy persons. Episodic memory is also impaired in depression. Therefore, we hypothesized that depressed persons with the “CC/TT” genotype combination would perform worse in comparison to other KIBRA and CLSTN2 combinations.

To examine the effects of KIBRA and CLSTN2 on episodic memory performance in nondepressed and depressed elderly persons (60+).

Genotyping from peripheral blood samples and episodic memory testing were performed in the population-based SNAC-K study. All non-demented participants (n = 2332) were categorized according to depression status (nondepressed/depressed) following ICD-10 criteria. Dichotomous variables were used for KIBRA (any T/CC) and CLSTN2 (any C/TT).

A three-factor MANCOVA revealed no main effects, but two significant interaction effects for episodic memory performance. Post hoc test for KIBRA × CLSTN2 revealed that persons with the “CC/TT” genotype exhibited poorer performance on free recall and recognition. Further, the three-way interaction (KIBRA × CLSTN2 × depression) showed that the negative effect of the “CC/TT” genotype was most pronounced among depressed persons Depressed “CC/TT” consistently performed at the lowest level.

The combination of the KIBRA “CC” and the CLSTN2 “TT” genotypes was associated with poorer episodic memory performance in both nondepressed and depressed persons. Depression in combination with the “CC/TT” genotype was especially disadvantageous for episodic memory performance. This supports the view that effects of specific SNPs on performance may be most easily disclosed at suboptimal levels of cognitive ability, e.g. in depression.

Current standard treatment of chronic hepatitis C (CHC) consists of pegylated recombinant interferon alpha (PEG-IFN-α) combined with oral ribavirin (RBV). Interferon treatment is associated with depressive simptomatology. Risk factors such as duration of CHC, former drug addiction, lifetime psychiatric disorder, sex, duration of therapy, dose of PEG-IFN-α have been shown to be associated with depression in patients with CHC.

To prospectively evaluate association of depression and specific risk factors in patients with CHC treated with PEG-IFN-α.

The Hamilton Depression Rating Scale was used to asses depressive symptoms in 74 subjects with CHC before PEG-IFN-α (mean dose 152.6 ± 25.6 mcg), and in the follow-up visits (4, 12 and 24 week). the sociodemographic and hepatitis C related history of the patients were examined on the basis of medical chart review.

After controlling for baseline HAMD scores, only female sex was confirmed as a risk factor for depression (p = 0.008) at fourth week after baseline. No association was found with any of three groups of risk factors:

1. 1) Subject related risk factors (age (p = 0.955), sex (p = 0.008), lifetime psychiatric disorder (p = 0.656)),

2. 2) Illness related risk factors (duration of CHC (p = 0.267), i.v drug aplication as way of transmission (p = 0.292)) and

3. 3) Therapy-related risk factors (recommended duration of PEG-IFN-α (p = 0.993) and dose of PEG-IFN-α (p = 0.841)).

Common risk factors were not found to correlate with depressive simptomatology in CHC on PEG-IFN-α. Hepathologists are encouraged to use self-assessment depression scale instead of relying on any of the routinely assesed risk-factors.

In patients with Schizophrenia an association between smoking and improvement in cognitive deficits was found. Patients with Major Depressive Disorder (MDD) and Bipolar Disorder (BD) have shown a high prevalence of smoking habit and cognitive deficits but only a few studies have investigated the effect of smoking on their cognitive functions.

To study the effect of nicotine assumption on cognitive function in MDD and BD.

50 inpatients with MDD and 50 with BD (Major Depressive Episode) underwent a neuropsychological test battery (Anna Pesenti test, Attentive Matrices, Rey-Osterrieth Complex Figure, Phonemic/Semantic Fluency tests, Token test) at the beginning of their hospitalization. Smoking habit (current, lifetime) was investigated by specific questionnaires. Factorial ANOVA models were applied, with cognitive test scores as dependent variables and smoking (smoker/non-smoker) and diagnosis (MDD/BD) as factors.

Smokers showed significantly better performance in verbal memory (p < 0.001) and fluency tests (phonemic p = 0.012; semantic p = 0.023) than non-smokers. Significant and positive correlations were found between the scores of these tests and the number of cigarettes smoked in the 24 hours before, while no associations with the years of smoking habit were found. No effects of diagnosis or interaction between smoking and diagnosis on the cognitive performance were found.

Animal models show that nicotine can increase the monoamine levels in brain areas involved in memory and language functions. Our results suggest that the positive effect of smoking on cognitive functions may contribute to increase the smoking habit in patients with Mood Disorders as a self-medication strategy.

Vagus somatosensory evoked potentials (VSEP) were proposed for the detection of Alzheimer's disease (AD) because of the degeneration of specific brainstem structures including Vagus nuclei early in the course of disease.Our objective was to contribute a means for differentiating between Major depression (MD) and AD. Our aim was to investigate if VSEP will be able to differentiate between healthy controls and MD where opposite to AD no brainstem involvement should occur.

In 57 subjects with MD and 57 healthy controls the stimulation of the auricular branch of the Vagus nerve (ABVN) was done at the inner side of the tragus applying electrical square impulses (0.1 msec duration, interstimulus interval 2 sec, stimulus intensity 8 mA). Evoked potentials were recorded bipolarly from the electrode positions C4-F4 and Fz-F4 (band-pass 0.1 Hz to 1 kHz, analysis time 10 msec, averaging of 100 artefact-free epochs). Statistical analyses were performed by means of ANOVAs for repeated measurements with the inner-subject factor “recording site” and the between-subject factor “diagnosis”.

ANOVAs for the VSEP latencies P1, N1 and P2 did not show any significant effect including the factor “diagnosis”. Conlusions VSEP latencies did not show statistically significant differences in subjects with MD as compared to healthy controls. This finding not only underpins the specifity of the results of VSEP in AD with longer latencies in patients than in controls but also points to a possibility to use VSEP as a method for the differential diagnosis of AD and MD which is often difficult to afford in older patients.