Recent findings in cognitive neuroscience indicate that activation of anterior cingulate cortex (ACC) is related to detecting cognitive conflict, dissociation and pain. Conflict related and pain experience induced ACC activation elicits responses in central autonomic network which can be assessed by psychophysiological measures such as heart rate variability (i.e. beat to beat R-R intervals- RRI). Recent findings in neuroscience also suggest that cognitive conflict is related to specific nonlinear chaotic changes of the signal generated by the neural systems.

The present study used Stroop word-colour test as an experimental approach to the study of cognitive conflict in connection with RRI measurement, psychometric measurement of dissociation (DES), somatoform dissociation (SDQ-20), and calculation of largest Lyapunov exponents in nonlinear data analysis of RRI time series in 45 patients with unipolar depression (i.e. depressive period or recurrent depression).

Significant correlation 0.57 (p<0.01) between largest Lyapunov exponents and DES, and 0.45 (p<0.01) between largest Lyapunov exponents and SDQ-20 found in this study indicate that cognitive conflict related defect of neural inhibition during conflicting Stroop task is closely related to dissociative processes and depression.

These findings suggest the hypothesis that specific nonlinear dynamics governs the brain processes that link psychological pain related to dissociation and somatoform dissociation related to painful physical symptoms as a consequence of ACC activation.

Prior meta-analyses have suggested superior efficacy of venlafaxine compared to SSRIs. In this meta-analysis we compared the efficacy of venlafaxine and SSRIs in patients with MDD classified according to baseline severity

Data from 31 venlafaxine studies were pooled and remission rates defined as <8 on the HAM-D17- score were analyzed. Subjects were divided into two groups based on their baseline HAM-D-17 total score ≥30 / < 30. Fisher's exact test was used to compare the treatment effects on the remission rates for each subgroup. All of the analyses were based on intent-to-treat patients, LOCF and completer analysis were performed using standardized measurements.

5836 patients with a baseline HAM-D17 <30 could be identified. The LOCF analysis revealed, that the OR is 1.31 (95%CI 1.18, 1.46), p<0.001 and the NNT is 16, whereas the completer analysis revealed, that the OR is 1.25 (95%CI 1.09, 1.43), p=0.001 and the NNT is 16. Remission data for 656 patients with a baseline HAM-D17 >30 were available. The LOCF analysis revealed, that the OR is 1.55 (95%CI 1.10, 2.18), p=0.015 and the NNT is 11, whereas the completer analysis revealed, that the OR is 1.93 (95%CI 1.25, 2.97), p=0.003 and the NNT is 7.

This analysis demonstrates that venlafaxine is superior to SSRIs in both the mild/moderate and severe depression in achieving remission. However, the magnitude of superiority was higher in the subgroup of patients with a baseline HAM-D17 >30 suggesting a pronounced clinical benefit for the treatment of severely depressed patients.

Disturbed action monitoring has been demonstrated in Major Depressive Disorder (MDD). A well-known marker for performance monitoring is the error-related negativity (ERN), an event-related potential (ERP) generated in the anterior cingulate cortex following erroneous responses. The aim of the current study was to explore the mood state dependency of the ERN in MDD.

Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in 15 patients with MDD and 17 matched controls. Measurements took place during the early stages of a depressive episode and again following 7 weeks of antidepressant treatment. The healthy volunteers also participated in both sessions.

Whereas speed of response had substantially increased at session 2 in both groups with larger increases in the MDD group, equal ERN amplitudes were demonstrated between both sessions for the controls as well as the patients. The equal amplitudes in the MDD group might be attributable to the great variance in mood symptom remission rates in our sample. Nevertheless, strong correlations between inter-session changes in symptom severity and ERN amplitudes did emerge in the patient group.

The present ERP results indicate that performance monitoring in MDD is affected by mood state with only totally remitted patients demonstrating increased ERN amplitudes. The observed behavioural performance adjustments in all patients might mainly be attributable to a practise effect and the (partial) remission of depressive symptoms. Future longitudinal studies that include only patients with total symptom remission should corroborate and refine the current findings.

Antidepressant use has risen x3-5 in Western countries since the early 1990s, outstripping changes in depression incidence or prevalence. This represents a major public health challenge.

Nationally-collected antidepressant data were used to assess the impact of "Doing Well", (DW) a novel depression care programme operating in Renfrewshire, Scotland. "Doing Well" implemented a model of “stepped collaborative care”, practitioner education and significant service redesign. Prescribing was compared for three groups: "DW" (76,000 population; clinical and educational intervention), "DW neighbours” (101,000 population; educational interventions only), and Scotland (no specific intervention).

A national rise in antidepressant prescriptions was stabilised for the "DW" group (graph). Antidepressant cost/item fell by 42% and 40% in both “DW” and “DW neighbours” groups but rose by 8% nationally.

Access to clinical interventions are required to reduce antidepressant prescriptions, but cost savings may be made with educational interventions alone.

To evaluate functioning, well being, and pain outcomes with desvenlafaxine succinate (DVS) treatment in depressed men and women of different age groups.

Data from the Sheehan Disability Scale (SDS), 5-item World Health Organization Well-Being Index (WHO-5), and Visual Analog Scale–Pain Intensity (VAS-PI) were pooled from 6 double-blind, placebo-controlled, 8-week DVS trials conducted in outpatients with major depressive disorder (MDD). Patients were divided into 3 age groups. The 18-39 and >55 years of age groups were chosen as proxies for pre- and postmenopausal status; the age group of 40-55 years, which was likely to include perimenopausal women, was also evaluated. Male patients were similarly grouped to differentiate effects of menopausal status from age on treatment response.

Patients were randomized to receive DVS 100-400mg (N=1048; 18-39 years [n=451]; 40-55 years [n=457]; >55 [n=140]) or placebo (N=718; 18-39 years [n=306]; 40-55 years [n=310]; >55 [n=102]). The final SDS, WHO-5, and VAS-PI overall pain change from baseline for the total population were significantly greater in the DVS vs the placebo group (P<0.001). Mean differences (adjusted ANCOVA) from placebo in women were: SDS: 18-39: –2.1, 40-55: –2.1, >55: –3.2; WHO-5: 18-39: +1.1, 40-55: +1.8, >55: +3.3; VAS-PI 18-39: –1.4, 40-55: –5.2, >55: –9.1. In men, results were consistent across age groups studied (SDS: 18-39: –2.9, 40-55: –3.4, >55: +2.6; WHO-5: 18-39: +1.5, 40-55: +2.4, >55: –0.3; VAS-PI 18-39: –3.0, 40-55: –7.7, >55: +2.0).

DVS improves functional outcomes and pain symptoms in depressed men and women across the age groups studied.

Current studies on Coronary Heart Disease (CHD) show significant relationship with depression, which play important role in the course and clinical pictures of the illness. Depression is connected with worse course and more pessimistic prognosis in patients with CHD.

This study is expected to lead to better understanding the etiopatogenesis of CHD and its connections with depression and to create an efficient treatment programs in these disturbances.

Two methods estimating intensification of depressive symptoms were used in this study; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS)

To explore the connection between depression and CHD the investigation has been conducted in a group of 111 patients with different course of CHD. The age of the group was 41-65 years (mean = 55; SD = 5,6).

The results of the study indicated the sub clinical state of depression in the whole investigated group. The highest values of BDI and HDRS were noticed in women as well as of men and women with disability pension or in pensioners.

We conclude that women with CHD have higher level of depression and the active employment status has protective influence on the mood.

The meta theory of selection, optimisation and compensation is a concept of successful coping and especially “successful” aging (1,2). Since depression is the most prevalent psychiatric disorder in old age, we wanted to know whether depression is associated with impairment of SOC-competence on a state or trait basis.

In a pilot study n=50 inpatients took part after informed consent. They were between 21 and 73years old and suffered from a depressive syndrome (F32, F43.2, F33, F43.1, F31, F41.2). Patients with organic and/or psychotic underlying condition werde excluded. We applied a standardised scale, developed by Freund & Baltes (3). Together with standard instruments (MADRS, GDS) at the beginning and the end of inpatient treatment. For this study, data from a representative German study (ALLEE) served as control.

As to be expected, SOC-competence was significantly lower compared to normal values in the depressed state. After remission however, there were no differences left. There were also no significant differences found when comparing a group of younger (<50y) and a group of older (>50y) patients.

We draw the preliminary conclusion that impairments in SOC competence seem to be no trait marker for depression at any age. Further study should test whether there are differences in various subtypes of depression (e.g. early versus late onset, double depression…..).

According to recent findings detecting a cognitive conflict is related to activation of anterior cingulate cortex (ACC) and central autonomic network. Several recent findings also suggest the hypothesis that the cognitive conflict is related to specific nonlinear chaotic changes of the neural signal. This conflict related activation elicits autonomic responses which can be assessed by psychophysiological measures such as heart rate variability calculated as beat to beat R-R intervals (RRI).

The present study used Stroop word-colour test as an experimental approach to psychophysiological study of cognitive conflict in connection with RRI measurement, assessment of serum cortisol and calculation of largest Lyapunov exponents in nonlinear data analysis of RRI time series in 32 patients with unipolar depression.

Significant correlation –0.43 (p<0.01) between largest Lyapunov exponents during conflicting Stroop task and serum cortisol levels has been found.

The study indicates that a defect of neural inhibition during conflicting Stroop task is closely related to decreased serum cortisol levels which probably reflect defense psychological mechanisms.

The impact of HSV infection on psychiatric status of patients correlates with the disease nature and duration. Recurrent genital herpes can have a major impact on sufferers' sex lives. HSV recurrences are often accompanied by anxiety and depression, up to suicidal attempts.

Purpose of this study is to investigate clinical typology of depressive disorders of HSV patients.

The clinical structure of the depressive disorders was estimated in 44 outpatients (26 men and 18 women, mean age - 31,2) with frequent genital HSV recurrences (>6 per year). Depressive disorders were diagnosed with a help of psychopathological method and the following psychometric scales: HAM-D-21; CGI-S and SOFAS. The normal values for each scale are <7, >80 and ?2 respectively.

Our screening data revealed depressive disorders in 32 of 44 patients. According to ICD-10 classification of Mental and Behavioural Disorders, recurrent depressive disorder, current episode mild [F33.0] was revealed in 15 patients (34,1%); recurrent depressive disorder, current episode moderate [F33.1] in 11 cases (25,0%) and dysthymia [F34.1] in 6 patients (13,6%).

These results testified that patients with genital herpes need psychiatric consultation. If an affective disorder is revealed a combined therapy should include both specific antivirus treatment and antidepressant therapy: Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).

Depression is one of the leading indications for using Complementary and Alternative Medicine (CAM). This paper reviews the evidence of efficacy of different types of CAM in depression with the aim of identifying the highest level of evidence for each approach.

We conducted literature searches restricted to the English language for studies on CAM as monotherapy in depression. All papers were reviewed by two researchers and the evidence was ranked according to a widely referenced hierarchy of evidence. Studies that addressed depressive states outside ICD and DSM based diagnoses of depressive disorders were excluded to ensure homogeneity.

19 papers formed the final review. We found Grade 1 evidence on the use of St. John's wort, Tryptophan/ 5-Hydroxytryptophan, S-adenosyl methionine, Folate, Inositol, Acupuncture and Exercise in Depressive disorders, none of which was conclusively positive. We found RCTs at the Grade 2 level on the use of Saffron (Herbal medicine), Complex Homoeopathy and Relaxation training in Depressive disorders, all of which showed inconclusive results. Other RCTs yielded unequivocally negative results. Studies below this level yielded inconclusive or negative results.

Searches were restricted to the English language. Our list of CAM approaches may not have been comprehensive. We excluded studies on the use of CAM as adjunctive treatment and aimed to identify only the highest level of evidence.

None of the CAM studies show evidence of efficacy in depression according to the hierarchy of evidence.

Our investigation is an prospective analysis of group of patients treated in Primary Health Care Center "Savski venac", department of neuropsychiatry in Belgrade, Serbia. Thru the time period of 8 years we analyzed reactions connected with exposing to stress events which are consequence of war actions in Serbia in 1999, especially worsening of symptoms of depression until 2007 in patients with no history of mental illness.

Research included 100 patients from Belgrade, Serbia, average age group of 50 years and approximate equal number of male and female sex. They are divided in two groups in dependence of level of education. For examination we used: (1) original question mark – questions about reactions which frequently have people exposed to very stressful events, and (2) Hamilton Depressive Scale (HAMD)

(1) Immediately after war actions in both groups are observed elements of PTSD; (2) in both groups during the time we have occurrence of depression, anxiety, raise of irritability, impulsivity, appearance of aggressiveness, suicidal tendencies, abuse of psychoactive products and alcohol with disorder of interpersonal relationships, disappointment in institutions of state and society ; (3) in 2007 are discovered significant increase of depressive score (HAMD) at 45% of tested patients without significant distinction between groups.

Stress events as consequence of war 1999 is the reason of appearance and worsening symptoms of depression thru the time period of 8 years.

Alcohol abuse may result in symptoms of depression. The objective of this study was to investigate the effect of detoxification on depressive symptoms in alcohol abusing/dependent subjects

The sample comprised 240 alcohol dependent individuals (175 males, 65 females) who were treated either with sole psychotherapy or psychotherapy and pharmacotherapy as an adjunct. The Zung Depression Scale (ZDS) was used for the assessment of depressive symptoms. The scale was administered at the beginning and at the end of the detoxification period that lasted 4-6 weeks. T-test for paired samples was used for the comparison of Zung scores between the two time points.

Mean age of subjects was 46,4±11.1 years (male: 46.7±11.3, female: 45.6±10.9) and mean alcohol consumption was 316.5±218.7 gr/day, (male: 367.3±223.9, female: 151.8±70.6 gr/day). Scores were indicative of severe symptoms of depression (score >70) before initiation of treatment. By the end of the detoxification period psychopathology significantly subsided (admission vs. discharge: 76.3±5.8 vs. 35.7±3.9; p<.000).

Alcohol abusing/dependent individuals exhibit severe depressive symptoms, as assessed through the ZDS. Following 4-6 weeks of detoxification these symptoms subside and reach normal levels. These results are in agreement with previous findings of our group with the use of Hamilton Depression Rating Scale as the assessment tool.

The relationship between drug abuse and vulnerability for psychosis still remains insufficiently understood. A proportion of the schizophrenia syndrome could be due to drug abuse in the absence of genetic vulnerability. The objective is to test the association between drug abuse and attention endophenotype in schizophrenia.

One cross-sectional study was carried out in a sample of 70 schizophrenia in-patients in acute state. It was defined two groups of schizophrenia patients: with (n=25) and without (n=45) drug abuse. The attention endophenotype was measured using CPT (X version, d prime parameter). It was controlled for: general neuropsychological performance (Trail Making Test A and B, Stroop Test), symptoms (PANSS, SANS, SAPS), basic symptoms (FCQ-III), clinical global impression, functioning (GAF), treatment, extrapyramidal side effects and akathisia. After Z-score transformation, performance in CPT was compared between the two groups using the student's t test. When necessary we used regression models for the adjustment of control variables.

Schizophrenia patients with drug abuse had a better performance in CPT (effect size: 0.71; p=0.004). Both groups were comparable in terms of the control variables except for Trail Making A, but when controlling for this variable the difference remains significant. Nevertheless, Trail Making Test is linked to attention process, so the differences can be explained by the different performance in both groups.

Schizophrenia patients with drug abuse had less genetic vulnerability for the disease when using attention vulnerability markers. In this cases the use of abuse drugs probably have had important aetiological implications.

To assess and compare the quality of life in HIV patients with and without depression.

100 HIV positive subjects were interviewed in a case control study. Subjects were interviewed by a psychiatrist to diagnose depression and HAM-D was used to rate the severity of depression. HAT-QOL was employed to assess Health related Quality of Life in these patients.

50 HIV patients were diagnosed to be depressed. 23% were mildly depressed, 19% were moderately depressed, 7% were severely depressed and 1% was very severely depressed. Mean QOL scores in depressed HIV patients were found to be significantly lower than that in non-depressed patients in all 9 dimensions.

HIV itself impairs QOL in HIV patients. Depression further worsens the QOL in these patients. Diagnosing depression in this set of HIV patients is the first step towards improving their Quality of Life.

The mean oral methadone dosage is reported to be 60-100 mg per day (Vazquez 2006).

We measured methadone oral dosages in three methadone clinics in Paris (Espace Murger, Marmottan, Horizons). The number of patients evaluated was 197. They were all at the steady state of methadone treatment. The influence of sex, center, age and retention in the program on prescribed oral dosage was tested with khi2 and spearman tests.

The mean dosage was 52 mg/d (+/- 28). The mean retention in the methadone program was more than three years. The dose range was [5-130]. The dosage was not different according to sex (p= 0,388), retention (p = 0,744), and age (p = 0,144). But the dosages were statistically different according to the center: 60 mg/d in Horizons (N = 37), 54 mg/d in Murger (N = 104), and 44 mg/d in Marmottan (N = 56) (p = 0,022).

This study confirms the great variability of methadone oral dosages in France, with a center-effect. Dosages that were found are still lower than what is found in other countries [5-350 mg/j] (Eap 2000). Other variability factors are to be considered: clinical, pharmacokinetic and pharmaco-dynamic factors.

[1]. Vazquez V, Gury C, Laqueille X. Méthadone : de la pharmacocinétique à la pharmacologie clinique. L'Encéphale 2006 ; 32 : 478-86

[2]. Eap CP, Bourquin M, Martin JL, et al. Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment. Drug and Alcohol Dependence 2000 :61,47–54

To compare the tolerability and efficacy of escitalopram and duloxetine in the treatment of patients with major depressive disorder over 8 weeks.

Data from two randomised, multi-centre, double blind studies in specialist1 or psychiatric and general practice settings were pooled and analysed for all patients and for severely depressed patients (baseline MADRS at least 30). The primary efficacy measure in both studies was the MADRS total score.

Patients were randomised to either escitalopram (10-20mg/day) (n=280) or duloxetine (60mg/day) (n=284). Escitalopram was statistically significantly superior to duloxetine with respect to mean change from baseline in MADRS total score at Weeks 1, 2, 4, and 8 (LOCF). The mean treatment difference at Week 8 was 2.6 points (p<0.01). For severely depressed patients, a mean treatment difference at Week 8 of 3.7 points (p<0.01) was seen. Response to treatment at Week 8 was statistically significantly greater for patients treated with escitalopram, as was remission when defined as MADRS<=10 or 12. The percentage of escitalopram-treated patients that withdrew (12.9%, n=36) was significantly (p<0.001) less than in the duloxetine group (24.3%, n=69). Significantly fewer (p<0.001) escitalopram-treated patients withdrew due to adverse events (4.6%, n=13) than from the duloxetine group (12.7%, n=36).

Escitalopram showed advantages in efficacy and tolerability compared to duloxetine in the acute treatment of patients with major depression. There were additional benefits for escitalopram-treated patients with severe depression.

This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder (MDD).

Patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram (20mg) (n=144) or duloxetine (60mg) (n=151). The primary analysis of efficacy was an ANCOVA of change from baseline to endpoint (Week 24) in MADRS total score (last observation carried forward).

At Week 8, the mean change from baseline in total MADRS score was -19.5 for escitalopram-treated patients (n=143) and -17.4 for duloxetine-treated patients (n=151), a difference of 2.1 points (p<0.05). At Week 8, the proportion of responders (at least 50% decrease in MADRS) was 69% (escitalopram) and 58% (duloxetine) (p<0.05) and remission (MADRS<=12) rates were 56% (escitalopram) and 48% (duloxetine) (NS). For the primary endpoint, the mean change from baseline in total MADRS score at Week 24 was -23.4 for escitalopram-treated patients and -21.7 for duloxetine-treated patients, a difference of 1.7 points (p=0.055, one-sided). The difference in mean change from baseline in MADRS total score favoured escitalopram at Weeks 1, 2, 4, 8, 12, and 16 (p<0.05). The overall withdrawal rates were 22% (escitalopram) and 26% (duloxetine) (NS). The withdrawal rate due to adverse events was lower for escitalopram (9%) compared to duloxetine (17%) (p<0.05) and significantly more patients treated with duloxetine reported insomnia (12.6% versus 4.9%) and constipation (8.6% versus 2.8%).

Escitalopram was superior to duloxetine in acute treatment, and at least as efficacious and better tolerated in long-term treatment of MDD.