Several neuropsychiatric pathologies have been recently linked to oxidative stress.

In this study, we investigated the relationship between depression, markers of oxidative stress and neurotransmission, as expressed by sensory cortex excitability.

Serum levels of oxidative stress markers and somatosensory magnetic fields, evokedby external galvanic stimulation, were measured in 13 depressed patients and 13 controls.

Depressives had higher levels of total and free copper than controls and lower levels oftransferrin. They also showed lower sensory cortex excitability, which correlated with copperlevels in controls, but not in patients. Transferrin correlated with sensory cortex excitability inboth patients and controls, although in opposite ways. Copper level results associated with thepatients’ clinical status.

Pro-oxidant agents appear to affect neuronal excitability and clinical state ofdepressed patients, as free copper excess alters their cortical glutamatergic neurotransmission.

Working memory dysfunctions are observed in patients with recurrent depressive disorders. These deficits exert negative effects not only on psychological test performance levels but also on the capacity of affected patients to cope with everyday life situations, as well as on decreased remission levels.

The goal of the study was to identify possible associations between spatio-visual working memory, evaluated on admission, with the remission degree, assessed after 8-week pharmacotherapy with SSRI in a group of patients with diagnosed depression.

141 subjects were examined (patients with depressive disorders, DD: n = 86, healthy subjects, CG: n = 55). Trail Making Test by Reitan (TMT) was used.

CG obtained higher results vs. DD-I patients (the evaluation started on the therapy onset) in TMT A/time (p = 0.09), TMT B/time (p = 0.009). CG demonstrated better results than DD-II patients (following eight weeks of pharmacological treatment) in TMT A (p = 0.11), TMT B (p = 0.85). Compared to DD-I group, DD-II group achieved better results in TMT A (p < 0.001) and TMT B (p < 0.001). The lowest performance levels in TMT A and TMT B may have been related to the highest depression levels after pharmacological treatment.

1. 1. Depressive disorders are associated with deteriorated efficiency of visual working memory.

2. 2. Antidepressant treatment resulted in improved of visual working memory.

3. 3. The better performance in TMT on the first day of treatment may have influenced the noted reduction in severity of depressive symptoms after treatment with SSRI.

Like all medical therapies, antidepressants have several limitations that clinicians should consider when choosing treatments for their patients. [1] Common long-term side effects of antidepressants are weight gain, sexual dysfunction, sleep disturbances, fatigue, apathy, and cognitive impairment. [2] These side effects will influence the quality of life and will be an important factor in determining the compliance to treatment for these patients. [3]

Is to present a study on weight gain in patients treated long term with antidepressants.

Methods: We made a retrospective study of 422 patients with Major Depressive Disorder hospitalized in First Clinic of Psychiatry Tirgu Mures, between Jan/2009 and June/2009. We built the study after patient data on the following criteria: age, sex, place of origin, educational level, occupation, primary diagnosis, BMI at first admission, BMI at the last hospitalization, the average years of treatment, the average hospitalizations and antidepressant treatment applied.

The vast majority of hospitalized patients were females (71%) in the age group 40-49. In summarizing this side effect of antidepressant treatment, we can say that weight gain is significant for long-term treatment with tricyclic antidepresives (64.38% of patients), tetra cyclic (50.30% of patients) and NaSSA (40% of patients). We found an increase of BMI of about 13.5% in these patients. For the patients treated with SSRIs, NDRI and SNRI we found that weight gain was present in less than 40% of patients and this had also influenced the compliance and the adherence to treatment of these patients.

This presentation addresses impacts of adjunctive aripiprazole (AA) in major depressive disorder (MDD).

Assess impacts of long-term (≤52 weeks) open-label AA to ADT on efficacy, sexual function and weight change in MDD.

Data were analyzed post-hoc from de novo patients enrolled in an open-label safety study of AA after inadequate response to one or more ADT. Three ADT classes were included: SSRIs, SNRIs, and a noradrenaline-dopamine reuptake inhibitor, bupropion.

Global well-being with AA was assessed (mean change in CGI-S score from baseline by ADT). Sexual functioning was assessed by Sexual Function Inventory (SFI) items: interest in sex, sexual arousal, achievement of orgasm, erection maintenance and sexual satisfaction. Item 6 captured change in the overall improvement score. Weight change at Week 52 (last observation carried forward) was assessed.

Overall mean change in CGI-S (n = 285) by Week 52 was -1.5. Mean changes in CGI-S from baseline scores (4.2-4.4) were: escitalopram (n=64) -1.5, venlafaxine XL (n = 48) -1.4, sertraline (n = 39) -1.7, fluoxetine (n = 41) -1.3, paroxetine or CR (n = 37) -1.5 and bupropion XL or SR (n = 46) -1.4. Improvements on SFI items (n = 155) ranged from -0.2 (sexual satisfaction) to -0.6 (interest in sex and orgasm). Mean overall improvement score (3.8) indicated mild-to-moderate sexual dysfunction. All AA groups experienced a mean weight increase (range +1.8 kg [sertraline] to +3.3 kg [fluoxetine]).

AA moderately improved CGI-S scores (to a similar degree) when added to three different classes of ADTs. Sexual functioning in patients on ADT modestly improved after adding aripiprazole to ADT.

Some studies showed auxilary effect of psychotherapy in patients suffering from depression treated by psychopharmacology. The aim of our study was to verify the treatment effect of training psychotherapy under the conditions of The Department of Psychiatry in Olomouc.

Total amount of 40 patients, who were hospitalized at The Psychiatric Department during the time period of years 2003–2004 with the diagnosis of Major Depressive Disorder-mild, moderate and severe form was included. 20 patients received psychiatric medication only (without any systematic psychotherapeutic support) and 20 remaining patients of the open psychotherapeutic department received combination of psychotherapy and pharmacotherapy. Psychopharmacological treatment was comparable in both samples as far as quality and quantity is concerned. We used at the psychotherapeutic department group training therapy and individual psychotherapy. Before the treatment was used HAMD and CGI- Seriousness of the disorder, before the end of the hospitalization and the therapy, we used HAMD and CGI/ Global Improvement.

Evaluation of the obtained data showed decrease on the HAMD scale (0,5 points) for the patients treated with the combination of psychotherapy and pharmacotherapy in the comparison with the group treated only with pharmacotherapy. This finding was even more obvious on the CGI scale, where the difference of the improvement reached up to 0,3 points again for the combined treatment, but were not significant.

In the treatment of the acute phase of Major depressive disorder, we did not prove a positive effect of the training psychotherapy.

The natural course of Major Depressive Disorder (MDD) encompasses the occurrence of alternating intervals of major depressive episodes and remission. While several abnormalities in neural circuits related to acute MDD have been identified, the neural mechanisms underlying stable remission remain obscure.

Acute MDD is characterized by increased amygdala and subgenual anterior cingulate cortex (sACC) activation and decreased connectivity between the amygdala and the sACC. Consequently, we expect those regions to be affected during remission.

To determine whether active counter-regulatory mechanisms are implicated in the maintenance of full remission once antidepressant treatment has been discontinued.

Functional and structural magnetic resonance imaging was used to measure brain activation and volume of the amygdala and the sACC. Images were obtained from 38 healthy subjects without any psychiatric life-time diagnosis and 38 gender-matched drug-free remitted MDD patients. Furthermore, correlation analyses were performed with clinical variables.

Patients with rMDD exhibited lower activation in the amygdala and the sACC and increased functional coupling between the amygdala and sACC compared to controls. This connectivity was particularly pronounced in patients characterized by a long cumulated time of depressive episodes. Similarly, structural connectivity results showed increased association between the amygdala and sACC volume in rMDD patients compared to controls.

Remitted MDD is related to neural alterations within a neural circuit encompassing the amygdala and the sACC compared to controls. These findings suggest active counter-regulatory mechanisms likely contributing to the maintenance of remission once treatment has been discontinued.

Depression rating scales play a decisive role in the assessment of the severity of depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in depression symptoms in patients with mild major, minor or subsyndromal depression (MIND).

Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales

1. 1) from assessment-to-assessment,

2. 2) in relation to depression severity level, and

3. 3) in relation to DSM-IV depression criterion symptoms.

The IDS-C28 was more sensitive in detecting changes in depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms.

Both scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.

Oxidative stress plays a role in producing advanced oxidation protein products (AOPP). High level of AOPP was observed in patients with such pathological conditions as ischemic heart disease, diabetes, cancer or neurodegenerative diseases.

A role of oxidative stress in depression and in antidepressant treatment has been implicated. There have been no studies so far on AOPP in psychiatric diseases.

Aim: An assessment of AOPP concentration, as a marker of oxidative stress, in patients with depression and the effect of antidepressant treatment.

Thirty-one patients hospitalized at Department of Adult Psychiatry, Poznan University of Medical Sciences, were studied. The first depressive episode was diagnosed in 5 patients, recurrent depressive disorder in 6 patients, and depression in the course of bipolar affective disorder in 20 patients. Patients were treated with venlafaxine (10), paroxetine (7), fluoxetine (5), clomipramine (4), citalopram (3), sertraline (1) and mianserine (1). Advanced oxidation protein products (AOPP) levels were measured twice: before treatment and in remission on maintenance doses of drugs. Control group consisted of 18 healthy volunteers, age- and gender matched.

There was no significant difference between depressed patients and healthy controls in the AOPP concentration before treatment. There was no correlation between AOPP levels and diagnosis, duration of illness, duration of the current episode and the age of illness’ onset. After antidepressant treatment, a significant decrease of AOPP concentration was found.

The results of the study may confirm previous data suggesting a decrease of some markers of oxidative stress after antidepressant treatment.

In recent years there has been a move towards treating depressed patients in the community.One factor that may reduce the likelihood of discharge from secondary care is suicidality. The aim of this audit was to identify factors associated with continued suicidality among Community patients.

We searched an anonymised database of patients and identified all those with previously documented suicidal thoughts or attempts. We also noted the presence of factors such as alcohol problems, drug problems, augmentation therapy and ‘other risk’ factors (e.g. financial problems or homelessness). We assessed the latest clinic letter, to see if patients were still reporting suicidality. We compared the aforementioned factors between the group of patients in which suicidality was still present (group N) and the group of patients in which suicidality was no longer a feature (group Y).

Of the 56 patients with suicidal thoughts or attempts there were 44 in group N (79%) and 12 in group Y (21%). Alcohol problems, drug problems and ‘other’ risk factors were more common among group Y than group N. Conversely, the percentage of patients on augmentation therapy was greater in group N than group Y.

The audit provides an insight into the factors that might influence outcomes among depressed patients.

Although the results are suggestive, it is difficult to make firm conclusions about patient outcomes on the present data. The audit provides a useful starting point, especially in considering the treatment of patients within the CMHT.

Treatment-resistant depression (TRD) has been a controversial issue for more than 35 years. Despite a large number of publications, clinicians and researchers still know few about the prevalence of TRD since no staging method has been validated.

We sought to assess similarities and differences between the 4 TRD-staging methods published to date and assess TRD prevalence in a clinical sample. We also wanted to look for clinical factors associated with TRD.

We conducted a clinical study in a psychiatric unit of a university hospital. We designed a hetero-questionnaire to stage TRD according to the 4 methods. Psychiatric diagnosis, depression severity and cognitive status were assessed using standardized tools. Patients were not included in the study if they suffer from schizophrenia, bipolar disorder, current substance dependence or major cognitive impairment.

We recruited 37 inpatients. Twenty-four had received an inadequate treatment, four had not responded after one adequate antidepressant trial and 9 after two trials. Only 7 were resistant according to the 4 staging methods, which showed several differences. The Massachussetts General Hospital (MGH) method appeared as the most specific and easy-to-use. Complete TRD seemed much less frequent than pseudo-resistance and relative resistance with untreated comorbidity. Chronic depression and comorbidity were frequent in the TRD subgroup.

The concept of “difficult-to-treat” depression might be more appropriate for clinical practice than TRD. The MGH tool seems to fit best to clinical practice. Further research is needed to confirm these descriptive findings in a larger sample.

NMDA receptor antagonists as ketamine represent fast-acting alternatives to monoaminergic-based antidepressants. Major drawbacks of these drugs are psychosis-like states and cortical neurotoxicity, effects correlating with potent activation of the cingulated and retrosplenial cortex. The molecular mechanisms underlying these side-effects have not been deciphered yet.

We aimed to determine potential molecular components of the NMDA receptor implicated in their psychotomimetic action and investigated whether subunit-specific NMDA receptor antagonists also induce similar neurotoxic changes as ketamine.

To investigate deleterious effects of NMDA receptor antagonists, we used brain mapping with the immediate early gene c-Fos. We analyzed the expression pattern of c-Fos in brain areas responsible for deleterious adverse events, after treatment with ketamine and the NR2B subunit-specific antagonist Ro 25-6981, both in wild-type and knockout mice, lacking either the entire NR2A subunit (NR2A ko mice) or its intracellular C-terminus (NR2A deltaC mice).

In contrast to ketamine (10mg/kg), Ro 25-6981, even at high dosages (50mg/kg) does not induce any c-Fos expression in the cingulated and retrosplenial cortex of wildtype mice. However, Ro 65-2981 evokes, both in NR2A ko mice and NR2A deltaC mice, strong c-Fos expression in these areas.

Our data indicate that blockade of both NR2A and NR2B subunits is necessary to induce deleterious effects specific for ketamine. Deletion of the C-terminus of the NR2A subunit is sufficient to disinhibit, together with pharmacological NR2B blockade, neuronal networks associated with psychosis. Therefore, NR2B antagonists may represent safer alternatives to ketamine as potential antidepressants.

The depression is emblem feeling of indisposition, shortage of energy, perish, and despair, to be useless, disinterestedness and pessimism

To assess prevalence of depression in nurses of Shiraz Namazi Hospital and it's connection with some effective factors.

In this cross-sectional survey, 130 nurses of Shiraz Namazi Hospital were Investigated by using Beck depression questionnaire. Also necessary data for independent Variables was collected by interview.

Depression rate of mild, moderate and severe types were 73.1%, 21.5% and 5.4%, respectively. Statistically significant association was found between depression and Marital status (P< 0.0001), level of education (P< 0.005), over time’s hours at work (P< 0.02) and parent’s death at childhood (before 11th age) (P< 0.001).

Various degrees of depression was found in this cohort and that affected their professional performance.

Depression is a serious condition that can impact every area of your life. Female depression and even the pattern of symptoms are often different.

The aim of this research study is to investigate the rate of server depression in those who use propellant. In order to achieve this objective, 260 patients volunteered to participate in this investigation and they were referred to the family planning clinic at Hafez hospital, and were planted capsule of Norplant.

In order to further fulfill selection process of patients suitable for this project, 200 of the most suitable candidates who suffered from even minor depression but had no history of congenital and familial major depression were selected and considered fit for this research work.

The results drawn from this investigative study can be summarized as follows;

1-The relationships between progesterone in anti pregnancy compound tablets, major depression and anxiety were recognized from many years ago. Norplant which is progestin itself can also be regarded as the cause of these conditions.

2-This investigation concluded that, among those patients studied, only 0.5% started having major depression as a result of the plantation. Therefore, Norplant was removed from their body.

A good consultation, awareness, correct guidance and efficient method of educating people before using Norplant, seeking prompt referral advice and future follow ups, will result in an effective way of preventing, diagnosis and treatment of these side effect conditions.

In recent years many investigators have paid attention to anabolic balance in depression. They highlight the importance of the ratio of anabolic and catabolic processes for prognosis of the outcome of depression. Some researchers suppose that cortisol/DHEAS ratio and growth hormone (GH) are important markers of anabolic balance. The aim of the study was to investigate the impact of severity and duration of depression on the anabolic balance in depression

79 patients with depressive episode were examined (F 32.0-2), 64 males and 15 females. Depressive symptoms were evaluated by the Hamilton Depression Scale (HDS). Anxiety was evaluated by Hamilton Anxiety Scale. Blood samples were drawn before antidepressant treatment. Serum DHEAS, cortisol and growth hormone levels were measured using ELISA kits.

There was a negative correlation between cortisol level and duration of depression (r = - 0,47, p = 0,037). Cortisol/DHEAS ratio in patients with severe depression was significantly lower than in patient with mild depression (287 ± 89 and 374 ± 87, respectively, P = 0,002). Patients with early stage of depression have increased levels of catabolic hormones that have positive correlation with the severity of anxiety. Patients with long duration of depression have decreased levels of both anabolic and catabolic hormones.

Our data demonstrate that depression can cause serious changes in the balance of anabolic and catabolic hormones. We can assume that the long duration of depression can cause exhaustion of HPA-axis.

Alexithymia appears as an inhibition of recognizing and describing the mental conditions. It is often connected with psychosomatic illness or depression.

The aim of this study was to compare depressive patients with healthy persons in terms of the prevelence and level of the alexithymia and pain feeling.

The examined group (E) consists of 16 patients with diagnosed depression (11 women, 44,6±11,6 year old).The control group (C) consists of 14 randomly chosen persons (10 women, 40,0+/-15,3 year old) who achieved < 11 points in the Beck's Depression Inventory (BDI).The alexithymia level was examined with TAS - 26 questionnaire (difficulty of recognizing the feelings and somatic senses (ODR), concrete thinking (MK), difficulty of expressing the feelings (TRW) and the lack of imagination (U)). The intensity of pain was examined with the questionnaire SF-MPQ. The scale BPCQ was used to examine beliefs about pain control.

No statistical differences about age, sex, the U feature in TAS-26 scale and the results of BPCQ test were shown. The differences beetween groups E and C appeared in the alexithymia intensity range (75,3 ± 14,4 v.62,4 ± 8,2pts, p = 007), the ODR feature (23,7 ± 6,7 v. 13,0 ± 4,1pts, p< 0,001), MK (18,9 ± 4 v.23,1 ± 5,3pts, p = 0,036) and TRW (13,4 ± 2,6 v. 9,6 ± 2,8pts, p = 0,001). The E group featured significantly higher pain intensity(p = 0,012).

The patients with depression suffer from alexithymia very often. The prevalence of upper difficulties and great intensity of pain could suggest a psychotomatic component of pain affections.

Depression is a significant problem of our civilization. It is said that 10–20% of basic health care patients have depressive disorder. Its etiology is complex and multifactorial. Guilt feeling is one of accessory symptoms, but only small part of psychiatric literature is concerned with this problem.

The aim of the study was to find the correlation between guilt feeling and the level of depression and anxiety.

The study group involved 20 patients with depression diagnosed with ICD-10 criteria (14 females and 6 men aged 40–69 years). The depression level was determined using Beck Depression Inventory (BDI). The anxiety was assessed using State-Trait Anxiety Inventory (STAI) and guilt feeling using Interpersonal Guilt Questionnaire-67 (IGQ-67).

The results were statistically analyzed using Microsoft Excel. 5 patients didn’t have symptoms of depression in last week, 11 have mild-moderate and 4 moderate-severe depression. Weak, but not statistically significant correlations between interpersonal guilt feeling and the level of depression (r = 0,319), anxiety as state (r = -0,395) and anxiety as trait (r = 0,298) were found. Statistically significant was correlation between age and state anxiety (r = 0,138; p = 0,037).

There is no evidence of relationship between interpersonal guilt feeling and the severity of depression and anxiety. In elderly patients with depressive disorder the level of state anxiety is higher. It may be significant to the effectiveness of applied therapy.

We present a case report highlighting the central role of psychiatrist in care coordination in spite of current trends when care is fragmented and provided by specialist teams. The importance of organic causation in bio-psycho-social case formulation and its treatment is emphasized.

To demonstrate the range of skills employed by practicing psychiatrist in optimising the care of the patients.

The role of Psychiatrists in managing risk in the suicidal patient with depressive illness is paramount and central.

The highlights in a patient’s journey are revisited via a review of medical notes.

The opinions of allied professionals and the split in the team in addressing heightened suicide risk is highlighted. The emphasis is placed on reflecting on when to end active management and consider a maintenance postion for the patient.

The concept of continuity of care and specialist knowledge of person in enhancing quality of care and optimising the patient outcome is firmly established.