Anhedonia is a transdiagnostic psychopathological phenomenon that is considered a key feature for several disorders, primarily affective spectrum disorders. It exhibits a significant association with social and occupational maladjustment, reduced quality of life, and increased suicidal risk among psychiatric patients.

The aim of this study is to identify recommendations for psychotherapeutic assistance for patients with affective spectrum disorders.

A total of 26 patients with affective spectrum disorders (ICD-10 code - F33, F31) and the phenomenon of anhedonia were examined. We utilized neuropsychological methods aimed at investigating a wide range of cognitive functions (Dynamic praxis; Color interference test; Arithmetic Tasks; Number of skips and impulsive errors; Reverse and straight rows; Verbal fluency; Design fluency; Rey-Osterritz figure) and psychometric methods designed to diagnose various types of anhedonia (consummatory (TEPS), anticipatory (TEPS), social (RSAS), and physical (PAS)).

Among patients with depression, the consummatory type of anhedonia was the most pronounced. A relationship was found between anticipatory anhedonia and phonetic verbal fluency (r = 0.487; p < 0.01). Additionally, there were correlations between immediate (consummatory) pleasure experience and Rey figure errors (r = -0.349; p < 0.05). Social anhedonia was associated with phonetic verbal fluency productivity (r = -0.509; p < 0.01) and performance in visual fluency productivity (r = -0.473; p < 0.01).

The obtained results allow us to hypothesize that anhedonia is associated with difficulties both in evaluating and imagining possible positive stimuli, which leads to a lack of emotional response to the current stimulus. Thus, the availability of current pleasure may be linked to memory accessibility and regulatory function. When these domains are weakened, the respondent loses the ability to associate the current stimulus with positive past experiences, making it challenging to generate an emotional response in the current stimulus situation and disrupting the anticipation of pleasure. Based on the results, we propose the effective use of behavioral activation and work on the actualization of past experiences. Behavioral activation can be implemented by gradually introducing behaviors associated with past pleasures into the patient’s life, followed by cognitive restructuring aimed at focusing the emotional response on past and current stimuli. In addition to this, from a neurocognitive perspective, an additional element of therapy could involve training various types of cognitive functions, with an emphasis on the auditory modality.

None Declared

Major depressive disorder stands as one of the most significant mental health issues in the general population. It impacts the patients’ quality of life and increases both morbidity and mortality. Response and tolerability to available pharmacological treatments are often inefficient, sometimes requiring extended periods to achieve acceptable remission through combinations or augmentations. Non-pharmacological approaches constitute an element in the therapeutic options for this mental disorder. In recent years, there has been a growing interest in non-pharmacological biological treatment interventions. Among the principal ones are Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation (DBS), and Vagus Nerve Stimulation (VNS).

The aim of this paper is to review the current available literature to expand our knowledge about biological non-pharmacological treatment in depression, particularly ECT, TMS, DBS, and VNS.

A qualitative review was conducted over the last 5 years, using the Medline database through PubMed. We selected studies in English or Spanish that met the objectives of the review, excluding references in other languages. The scientific evidence obtained was analyzed and synthesized.

There is growing evidence in this area. TMS, whose place in clinical guidelines remains unclear, is a less available treatment but might be considered in patients with moderate to severe depression who cannot receive pharmacological treatment. DBS, which shows good results in treatment-resistant major depressive disorder, achieves response rates greater than 50%. VNS has accumulated studies since its approval for treatment-resistant depression, showing some latency of response but demonstrating improvement persistence for at least two years, although some studies have not clearly shown a benefit. We also found studies demonstrating the effectiveness and favorable cost-benefit balance of ECT.

This review highlights the importance of increasing knowledge in these types of treatments. They have shown significant progress in recent years. We have a better understanding and use of the technique of ECT, while newer options have gained evidence in effectiveness over these years, with improvements facilitating their use in patients with treatment-resistant depression.

None Declared

Depression is a highly prevalent, multifactorial, complex disorder, its etiology is assumed to involve both genetic and environmental factors. Genetic factors, including biological clock genes such as CLOCK and SIRT1, have been linked to depression, particularly its symptom related sleep disturbances. Environmental factors also play a crucial role in the background of depression, particularly in interaction with genetic factors. Known environmental stress factors include stress caused negative life events or childhood adversities.

This study aims to delve into the chronotype-specific impacts of genes previously correlated with circadian functionality on the pathomechanism of depression in interaction with environmental stress factors.

A genome-wide association study on the ‘morning chronotype’ phenotype was conducted with Plink2, utilizing data from the UK Biobank discovery sample (N = 139135). Using LDPred2we derived a polygenic risk score (PRS) for the NewMood Hungarian dataset (N = 1820). We performed pathway-specific analyses including genes implicated within the genetic pathway, drawing on prior research findings. Specifically, we selected the top genes (with a false discovery rate-corrected p-value < 0.05) from the “responders vs. non-responders” analysis conducted by Jerome C. Foo et al.Transl Psychiatry 2019; 9 343). We performed a main effect analysis investigating the pathway specific PRS’s effect on BSI depression scores and interaction analyses using life course (number of negative life events in the past life) and recent (number of negative life events in the past year) stress scores to investigate how the interaction term predicts depression in our target sample.

Our primary analysis revealed a nominally significant protective effect (beta = -20.90938, p = 0.070218). Subsequently, in the context of our interaction analysis, we identified significant risk associations, both with lifetime stress (beta = 13.7416, p = 0.0171) and recent stress (beta = 24.6034, p = 0.0038)

Our study unveiled a protective role in our primary analysis, juxtaposed with risk associations in our interaction analyses. This intriguing dichotomy underscores that this genetic pathway, associated with circadian dysregulation, exerts a protective influence in association with the morning chronotype. However, it transitions into a predisposing factor for depression when influenced by environmental stress factors.

Considering these findings, our study substantiates the hypothesis that both circadian genes and chronotype contribute to the pathogenesis and clinical manifestation of depression. Additionally, it underscores the pivotal role of stress as a contributing factor in the intricate pathogenesis of depression.

None Declared

Major Depressive Disorder (MDD) is associated with a high burden of disease and notable economic costs. Standard treatments (e.g. medication or cognitive therapy) have been shown to be effective, but some patients remain unresponsive. With the knowledge that MDD patients have been shown to display an attentional cognitive bias towards negative stimuli, Cognitive Bias Modification (CBM)-training to focus attention on positive information is thought to improve emotional processing and depressive symptoms. Some studies imply reduced duration and occurrence of microstate D in MDD compared to healthy controls. However, the effect of CBM on microstates is still unclear.

(1) To replicate previous findings that duration and occurrence of microstate D is reduced in patients with MDD compared to healthy controls in an independent sample and (2) to investigate the effect of an active CBM-training versus a control-training on microstates and its association with symptom improvements.

Thirty patients receiving outpatient treatment with MDD according to DSM V (aged 18-60) will be recruited in Essen and Aachen. The control group will consist of 30 healthy age-and-sex-matched participants. Psychological testing will be administered and all participants will be randomized to either an active or a control training. During the next visit, resting state EEG and a GoNoGo Task with positive, neutral and negative pictures will be measured. The participants will take a tablet home to undergo 10 sessions of CBM within 14 days. The training will be consisted of a dot-probe-task. In the active condition the probe will be more likely to appear behind a positive versus a neutral picture, while appearing randomly in the control condition. After 14 days, a second EEG will be recorded.

Differences in duration and occurrence of microstate D between patients and healthy controls will be analyzed by conducting ANCOVAs with age and sex as covariates. ANCOVAs for repeated measurements will be calculated to study effects of time (pre- vs. post-training) and group (patients vs. healthy controls in active training; patients in active vs. patients in control-training), on duration and occurrence of microstate D.

CBM-training is proposed to be an effective treatment option for MDD patients, reflected in a reduced topographical bias of microstate D in EEG.

None Declared

Dysfunctional changes in the glutamatergic system play an important role in the pathophysiology of depression. Glutamate regulates various neuronal function, such as nerve migration, excitability, plasticity, as well as long-term potentiation and long-term synaptic depression. Failures in this process might cause emotional/cognitive changes associated with stress-induced depressive symptoms, a part of our current understanding of the pathophysiology of depression. These changes might be related to deviations in biochemical blood parameters, but also to volatile organic compounds (VOCs) measured in breath.

1) To replicate our previous finding that concentration of volatile organic compounds in expiratory breath gas and metabolites derived from MR spectroscopy distinguish unmedicated depressed patients from healthy participants, (2) to determine whether the amount of these VOCs is associated with severity of depression and anxiety, and (3) to correlate breath-VOC-content with glutamatergic neurotransmission and energy metabolism derived from MR spectroscopy.

25 antidepressant-free patients with major depression according to DSM V (18-65 years of age) are recruited from our out- and inpatient clinics. The controls will consist of 25 healthy age-and-sex-matched participants. Breath gas analyses will be carried out at awakening, and 30 and 60 minutes thereafter, and at 5pm using PTR-TOF-MS with direct on time measurement through a special sampler. A 7 Tesla Siemens Terra MRI scanner will be used to undertake spectroscopic measurements. Concentrations of glutamate and β-hydroxybutyrate levels in the pregenual and dorsal anterior cingulate gyrus will subsequently be assessed.

Statistical analysis for differences between groups corrected for multiple measurements will be carried out. Concentration of VOCs will be correlated with brain metabolism and severity of symptoms.

VOCs in breath are proposed to be an efficient and non-invasive marker for depression-related biochemical changes related to disease severity, and eventually useful for personalized treatment planning.

None Declared

Anhedonia (loss of ability of experience pleasure) is a transdiagnostic symptom which is presented as a prominent complain in several psychiatric disorders, such as depressive disorders, schizophrenia, bipolar disorder, addictive disorders, certain personality disorders etc. Specific instruments for assessment of anhedonia have been published in the international literature but their Hungarian versions are not available so far, however, the prevalence of affective disorders and suicide are also high in Hungary. The Snaith-Hamilton Pleasure Scale (SHAPS) is an instrument developed in 1995 (Snaith et al. Br J Psychiatry1995;167:99-103) which purposley has been constructed with items that can be easily translated into other languages.

The aim of our study was to translate the 14 items into Hungarian and analyse its reability and sensitivity in a Hungarian sample consists of patinets and control persons. Further aim was to explore the differences of anhedonia profiles among diagnostic categories and subgroup of major disorders.

We recruited 170 subjects (101 controls and 59 patients; 78 men and 82 women; mean age=37,9±6,1y) into our study. Among the patients there were 27 subjects with major depressive disorer (MDD), 10 subjects with bipolar disorder (BD), 9 patients with schizophrenia (SCZ), 6 patients with addictive disorder (AD) and 7 patients with anxiety disorder (ANX)±. We created two major subgorups from the dfferent diagnostic categories: affective and psychotic subgroups to compare the anhedonic profiles. Differences of mean values between case and control, men and women and subgroups were analysed by t-tests and diganostic categories by ANOVA tests performing in SPSS 20.0 software.

Among the MDD, the BD, the SCZ, the AD and the ANX groups, patients with MDD produced the highest score (6.9±3.5; 3.9±2.4; 5.9±3.9; 2.8±2.7;2.3±1.8, respectively), while controls prohibited 1.6±1.3. The case group scored significantly higher on the SHAPS than the control group (5.3± 3.6 vs. 1.6±1.3; p=0.0001). The means of SHAPS did not differ significantly between the affective subgroup and the psychotic subgroup (6.0±3.7 vs. 4.8±3.2; p=0.24). Among the subgroup of women, the age was significantly associated with the SHAPS score (p=0,04), however, this association has been not detected in men.

The Hungarian version of the SHAPS detected marked difference between cases and controls with good reliability and sensitivity. The instrument can be useful in daily clinical routin becuase subjects could fill it easily and quickly. In case of patients with pronounced anhedonia, treatments with spcifically targeting anhedonia can be preferred (e.g. rTMS as it was demonstrated in our earlier publications, see Lazary et al. Sci Rep 2021,11:8867; Elemery et al. Front Psychiatry 2022, 13:806731). This study was supported by the grant EFOP 5.6.2.

None Declared

Difficulties in emotion regulation are known to be associated with various mental health problems, particularly depression, and anxiety.

This study aimed to explore the relationship between emotion regulation, depression, anxiety, and stress symptoms in a Tunisian university setting.

A cross-sectional, descriptive, and analytical study was conducted among Tunisian students from August to September 2023. Data were collected through an anonymous online questionnaire, assessing sociodemographic characteristics, the Arabic version of the difficulties in emotion regulation scale short form (DRES-SF), and the depression, anxiety, and stress scale (DASS-21).

A sample of 307 university students were enrolled. The sex ratio (M/F) was 0.28. In the assessment of emotional regulation difficulties, participants reported a mean total score of 42.47 ± 12.68. The mean score of stress was 18.2 ± 11.36, reflecting a mild severity. Participants with higher stress levels have more difficulties in emotional regulation (r=0.658, p=0.00). Participants with depressive symptoms showed a higher DRES-SF total score (r= 0.629, p=0.00). Participants had a mean anxiety score of 15.6 ± 10.57, reflecting a severe severity. A significant correlation between total DRES-SF score and anxiety (r=0.606, p=0.00).

Our study concluded significant positive correlations between depressive symptoms, anxiety, and stress symptoms with emotion regulation difficulties.

None Declared

In recent years, the prescription of antidepressants for children has faced significant scrutiny due to studies suggesting an elevated risk of suicide among those treated with these medications. The primary objective of this study is to examine the causal connection between antidepressant use and suicidal behavior in children and adolescents.

In this article, we will examine the current research on this topic and discuss the current status of practical guidelines and recommendations for prescribing antidepressants to children and adolescents.

We conducted a literature review using the Google Scholar database, employing keywords such as antidepressants, suicide, children, and adolescents.

The literature yielded conflicting data. While it has been established that SSRIs moderately elevate the risk of suicide ideation and attempts, with venlafaxine, paroxetine, and sertraline showing a higher risk compared to other SSRIs like fluoxetine and citalopram, several studies indicate that their use is linked to a noteworthy reduction in suicide rates among children and adolescents.

The existence of a definitive causal relationship between antidepressants and suicidality in children and adolescents is currently uncertain, and the underlying mechanisms remain inadequately understood.

None Declared

Major depressive disorder (MDD) is twice as common in women than men and is more frequently reported during their reproductive years (Shi et al. Front. Psychiatr 2021; 12 589687).  MDD affects up to 12.7% of pregnant women and can significantly impact foetal and maternal health. Hence, clinical practice guidelines recommend focused screening and expedited management of MDD in women (Guo et al. Obstet. Gynecol 2018; 131(4) 671-679). Despite this, drug labelling or dosing recommendations rarely account for gender or physiological differences between sexes, even though sex steroid level variations can impact drug absorption, distribution, metabolism, and activity both pharmacokinetically and pharmacodynamically (Soldin et al. Clin Pharmacokinet. 2009; 48(3): 143–157). Sertraline, an SSRI approved for the treatment of MDD, is one of the safer agents which can be given to childbearing or breastfeeding women (Cuomo et al. Expert Opin Drug Saf 2018; 17(7) 719-725). However, studies on the efficacy of sertraline for the treatment of MDD among women of childbearing age are limited.

This post-hoc pooled analysis evaluated the efficacy of sertraline in women with MDD, with a particular focus on women of reproductive age.

A pooled data analysis of 8 short-term clinical studies of sertraline in persons with MDD (comprising 1600 participants from North America and Europe, of whom 947 were females; with moderate to severe MDD [mean±SD baseline HAM-D17 score was 23.73±3.58 for sertraline and 23.37± 3.47 for placebo]; sertraline dose, 50-200 mg) was performed. HAM-D17 total score was used to assess the efficacy of sertraline compared with placebo. The study period was 8 weeks. An MMRM method was used to analyse changes over time and ANCOVA to evaluate the change from baseline at week 8 with LOCF employed to manage missing data.

The analysis set consisted of 947 women (sertraline, 612; placebo, 335). The change from baseline in HAM-D17 total score was significantly higher for sertraline than for placebo at the end of 8 weeks (LS mean difference, 95% CI: -1.81 [-3.01, -0.62], p=0.0029, Figure 1A). This change from baseline was statistically significant starting from week 2 and increased over time (Week 2-8; Figure 2A).

The analysis set for women of child-bearing age consisted of 572 participants aged 18-44 (sertraline, 359; placebo, 213) from 7 clinical studies. The change from baseline in HAM-D17 total score was significantly higher for sertraline than for placebo at the end of 8 weeks (LS mean difference, 95% CI: -2.08 [-3.52, -0.64], p=0.0047, Figure 1B). This change from baseline was statistically significant starting from week 2 (Figure 2B).

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Image 2:

Significant improvement in HAM-D17 scores was observed in the analysis, suggesting that sertraline is efficacious in treating women with MDD, including those in the childbearing age.

A. Fagiolini Grant / Research support from: Angelini, Boheringer Ingelheim, Janssen, Consultant of: Angelini, Biogen, Boheringer Ingelheim, Lundbeck, Janssen, Mylan, Neuraxpharm, Otsuka, Pfizer, Recordati, Rovi, Sanofi Aventis, Viatris, Speakers bureau of: Angelini, Apsen, Biogen, Boheringer Ingelheim, Glaxo Smith Kline, Lundbeck, Janssen, Mylan, Neuraxpharm, Otsuka, Pfizer, Recordati, Rovi, Sanofi Aventis, Viatris, Vifor, M. Mariano Consultant of: Johnson & Johnson, Otsuka Pharmaceutical Inc., Speakers bureau of: Viatris Pharmaceuticals, Inc. Otsuka (Philippines) Pharmaceutical, Inc. H. Lundbeck A/S, Johnson & Johnson Philippines, Inc., E. Biesheuvel Employee of: Viatris Inc. Netherlands, P. Purushottamahanti Employee of: Viatris Inc. India

Inflammatory joint diseases (IJD), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis/spondyloarthropathies (AS), and juvenile idiopathic arthritis (JIA), are more common in patients with depression. However, it remains unclear whether the strength of this association varies with the severity or level of treatment resistance of the depressive episode.

To assess the risk for IJD in patients with severe depression and TRD compared to population comparators and patients with non-severe and non-treatment resistant depression.

We conducted parallel cohort studies among 600,404 patients with a depressive episode identified in Swedish nationwide administrative registers. The prospective risk for IJD, both overall and per IJD condition, in patients with depression of any severity was compared to matched population comparators. Additionally, we assessed the same associations comparing patients with depression to those with severe or treatment-resistant depression. Analyses were adjusted for comorbidities and sociodemographic covariates.

Overall, patients with depression were at increased risk for later IJD compared to population comparators (adjusted hazard ratio (aHR) for any IJD 1.34 [95% CI 1.30-1.39]; RA 1.27 [1.15-1.41]; PsA 1.45 [1.29-1.63]; AS 1.32 [1.15-1.52]). The associations were not significantly different for patients with severe depression or TRD.

Patients with severe and treatment resistant depression are at higher risk for inflammatory joint disease than population comparators. This association does not seem to be stronger than for patients with non-severe or non-resistant depression. Severity and treatment resistance of a depressive episode as identified in register data may not be valid depressive phenotypes for predicting risk for inflammatory joint disease.

P. Brenner Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., J. Askling Grant / Research support from: Karolinska Institutet has entered into agreements with the following companies, with JA as PI: Abbvie, BMS, Eli Lilly, Galapagos, Janssen, Pfizer, Roche, Samsung Bioepis and Sanofi., D. Hägg Grant / Research support from: Affiliated employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., L. Brandt Grant / Research support from: Affiliated with/employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies., P. Stang Employee of: Former employee of Janssen Research & Development, LLC. The work on this study was part of the employment., J. Reutfors Grant / Research support from: employed at the center for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the performance of drug safety and drug utilization studies.

In Denmark, 14% of patients with depression develops treatment resistant depression (TRD) after the first hospital contact. Explanations for TRD include lack of clinical effect of pharmacological treatment and reluctance to treatment due to price, discomfort, and unacceptable side effects. Cold water swimming (CWS) describes swimming outdoors during the winter season in cold to ice-cold water on a regular basis. Many winter swimmers believe that exposure to cold water is beneficial for their health. However, evidence of health effects have been anecdotal or based on results from small sample-size studies. The availably studies report that winter swimming abolishes general tiredness, boosts self-esteem and improves mood and/or general well-being.

Aims To test if it is possible for patients with depression to participate in two weekly sessions of CWS and to measure the effects of CWS on general well-being and depression.

All psychiatric in- and outpatients from the department of psychiatry at Little Belt Hospital, Vejle with a diagnose of depression were eligible for inclusion. CWS-sessions included a dip in an inlet - and a short swim for a few minutes – depending on individual preferences.

The average water temperature was 7.5 grades C. The lowest water temperature was 2.0 grades C. 13 patients were participating in CWS sessions. One of the patients participated in 40 CWS sessions and the average number of CWS session was 14.5 (sd: 11.2). The participating patients were on average overweight, and they had mild to severe sleep problems with an average score of 10.1 (sd: 3.7) on Pittsburg Sleep Quality index. Patients with regular CWS have a wellscore of 39.2 and at the end of the swimming season, their score has increased to 54.0. Sleep: At index for regular swimmers, the score was 10.4 and at the end of season in had decreased to 8.0 while the patients’ not regular swimming had an unchanged score of 11.3. After each CWS sessions, a cheerful and uplifted atmosphere spread among the participants and the conversation afterwards was often characterized by this.

The nurses had an important task and function in guidance to the participating patients due to the patients’ symptoms from depression. It was surprisingly easy to get all the patients to swim in the cold water. Due to the design and small numbers of participants in this feasibility study, it is not possible to draw any statistically significant results. Nevertheless, we can conclude that it is possible to use CWS as a treatment opportunity for some patients with depression. The research group members are convinced that for some patients it will be an important part of recovery from depression. Further studies with control group and a statistical satisfying larger group of participants will probably generate more knowledge’s on these issues.

None Declared

Depressive disorders represent the main cause of disability in the world, due to its prevalence, its impact on the patient’s quality of life and its role as one of the main risk factors for suicide. Current antidepressant treatments can take weeks to take effect and months to achieve response and remission.It is estimated that up to 30% of patients with major depressive disorder (MDD) are resistant to antidepressant treatment, in addition, approximately 30-45% of patients with depression do not achieve an adequate response to the first antidepressant treatment.According to the STAR*D study, the more lines of treatment are required, the lower remission rates are estimated, as well as higher relapse rates during the follow-up phase.With the appearance of intranasal dosage esketamine allows the release directly to the central nervous system, the mechanism of action of esketamine is based on the antagonism of the NMDA receptor, which entails the modulation of the excitatory transmission of glutamate and the release of BDNF,activating neurotrophic signaling and synaptogenesis.

The objective is to expose the response after treatment with intranasal esketamine in a case of resistant depression.

A 55-year-old female patient, diagnosed with resistant recurrent depressive disorder.The patient had undergone treatment with different therapeutic lines with antidepressants, and potentiations with antipsychotics, observing little response in the current episode, for which reason we evaluated the indication of intranasal Esketamine. Scales: MADRS (Montgomery Asberg Depression rating scale) =37, Hamilton Depression Scale=25, PHQ-9=20, indicating severe depression.

After starting treatment with intranasal esketamine, an early response was observed. After the first month of treatment, mild depression was scored at MADRS=10 and moderate depression at Hamilton=14, PHQ-9=12, and at week 14 of treatment, it was scored mild depression in both MADRS and Hamilton. Intranasal 56mg esketamine plus 20mg escitalopram, 30mg mirtazapine and 5mg aripiprazole.

Intranasal esketamine offers a rapid reduction in depressive symptoms maintained over time, reducing the risk of relapse and with a favorable tolerability profile, so its use in depression resistant to treatment presents a great advance.

None Declared

Major depressive disorder (MDD) is defined as a mental disorder of multifactorial etiology, which presents with mood disturbance, mainly sadness associated with loss of interest or pleasure. Light therapy (LT) is a therapeutic intervention consisting of daily exposure to a light source. This study aims to evaluate the effects of LT on anxious-depressive symptomatology and sleep in a sample of patients diagnosed with depression.

This study aims to evaluate the effects of LT on anxious-depressive symptomatology and sleep in a sample of patients diagnosed with depression.

Prospective case-control study, in which the cases are outpatients diagnosed with MDD and the controls are healthy individuals. Both groups underwent LT sessions and were assessed by means of validated scales, anxiety and depression symptoms before and after LT sessions, as well as changes in sleep patterns through a sleep measuring device.

11 cases and 18 controls were included in the study. Of the participants, 62.1% were female and 37.9% were male. The mean age of the sample was 54.03 □ 11.55 years. There were significant case differences in the pre and post LT scores of the depression scale. There were no significant differences in the changes in superficial, deep and total sleep and in the anxiety scale scores.

In the sample analysed, LT has significant effects on the cases at the level of the depression scale.

None Declared

This review aimed to identify common pathophysiological mechanisms that exist between depression and obesity, as well as pharmacological strategies used in clinical trials and animal models. It is necessary to carry out larger studies that integrate the multiple neurobiological processes of these phenomena and the search for therapeutic targets that affect these pathways.

Conduct a literature review on the common neurobiological aspects that exist between depression and obesity. Compare pharmacological and therapeutic strategies in the management of depressive patients by means of common neurobiological mechanisms.

We used the Pubmed search engine to search for the keywords: ((depression and obesity) OR (common pathways for depression and obesity) OR (therapeutic targets for depression and obesity) OR (neurobiology of depression and obesity) OR (treatments for depression and obesity))Once the predefined screening was carried out, 68 studies were identified. 54 articles were left for review and analysis. At the end of the review, 25 studies were discarded, including 29 studies with relevance to the objectives described in the study. These articles were selected when they provided information with adequate, concrete and specific reasoning towards the scientific and methodological elements of the review.

Table 1: Findings related to the NEGR1 gene and its involvement in processes associated with alterations associated with depression and obesity.

Table 2: Findings of inflammation associated with depression and obesity in clinical trials and animal models.

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Alterations in the NEGR1 gene, inflammatory markers, HPA axis and microbiota demonstrate multiple pathophysiological mechanisms in the clinical pictures associated with obesity and depression.

Infliximab, pioglitazone, ondansentron, BVT.2733 and palmitoylethanolamide showed anti-inflammatory regulatory effects with reduction in depressive symptoms and multiple anti-inflammatory markers.

Animal models for obesity and depression present ample and reliable evidence regarding the use of drugs that direct their therapeutic profile towards the pathophysiological mechanisms involved in pathologies involving depressive and metabolic disorders.

None Declared

Depression, particularly in early adulthood, presents a significant mental health challenge with far-reaching implications. Innovative approaches to address and alleviate depressive symptoms are of paramount importance in this context. One such approach involves the utilization of technology, specifically chatbot-based programs, to target specific cognitive biases associated with depression.

The central objective is to empirically examine whether this program can effectively influence depressive mood and negative cognition in individuals grappling with depressive symptoms.

To ascertain the program’s efficacy, participants were divided into two groups: the CBM-I group (n=20), which underwent interpretation bias modification training, and the Mood Check group(n=20), which served as a control and engaged in a simple mood-checking exercise. A battery of psychological measures was employed, including assessments of depression, interpretation bias, suicidal ideation, resilience, and attention control.

Analysis results showed that the CBM-I group had a significant reduction in depression (PHQ-9, CES-D) compared to the Mood Check group in the post-measurement. Moreover, resilience (CD-RISC) and attention control (ACQ) significantly improved in the CBM-I group.

This research serves as a stepping stone towards a deeper understanding of how chatbot-based interventions can contribute to the management of early adulthood depression, offering new perspectives and possibilities in the realm of mental health support and treatment.

None Declared

Depression is one of the most prevalent and incapacitating disease in current times and depressive symptoms have important global functioning implications.

The serotonergic and glutamatergic systems are involved in the pathophysiology and treatment of depression. Ketamine is an N-methyl-d-aspartic acid (NMDA) receptor antagonist that has demonstrated an important role on depressive symptoms, but its use is restricted due to its dissociative effects and other possible adverse effects.

Memantine is a noncompetitive antagonist of the NMDA receptor that modulates glutamate transmission. Memantine is used for the treatment of moderate to severe Alzheimer’s disease.

In this review, we aim to investigate, organize and synthetize the current data about the use of memantine for depressive symptoms.

Our literature research focused on some of the most significative articles published in the last decade, including meta-analysis and systematic reviews.

Most of the relevant literature suggests that memantine may effectively reduce depressive symptoms in patients with mood disorders.

The literature also supports that memantine’s glutamatergic mechanism of action could reduce apathy and treat depression comorbid with alcohol abuse.

Memantine affects brain-derived neurotrophic factor(BDNF) production suggesting that glutamate assumes an essential role in the pathology and etiology of depression. Also, the relationship between depression and the NMDA receptor is further supported by the fact that people with major depressive disorder demonstrate higher glutamate levels in the brain and blood.

Moreover, current studies demonstrate that treatment with memantine as adjunct to selective serotonin reuptake inhibitors (namely sertraline) manifested a favourable safety and efficacy profile in patients with major depressive disorder.

Memantine may have a wide therapeutic use beyond its utility in neurodegenerative diseases.

More studies should be performed, especially larger controlled studies of longer duration focusing on long-term safety and efficacy.

None Declared

Depression represents a significant challenge in terms of disability among the elderly population and its responsiveness to conventional treatment approaches tends to diminish in this population group. Esketamine has shown both effectiveness and safety in addressing treatment-resistant depression in older patients.

Currently, there is a lack of available literature regarding the use of esketamine in the treatment of patients experiencing both cognitive decline and treatment-resistant depression (TRD). We administered esketamine to a 79-year- old patient to evaluate the effectiveness and tolerance of the medication.

We recruited a 79 year old female referred to the outpatient clinics of Pavia suffering from TRD with current Severe Depressive Episode (scoring 42 on the MADRS) with cognitive impairment (MMSE 16/30). The patient was on a fourth-line treatment. First-line treatment was started with paroxetine 40 mg from september 2021 to May 2022, switched to sertraline 50 mg. Second-line treatment with quetiapine 150 mg from June 2022 to December 2022 failed, despite optimal compliance for both lines of treatment. Then third line treatment with fluoxetine 20 mg, olanzapine 10 mg was initiated from December 2022 to May 2023. Study duration was 12 weeks. Anamnestic data and psychometric (MADRS, HAMD-21, HAM-A) and cognitive (MMSE and MoCA TEST) assessment were collected from medical records at baseline (T0), one month (T1) and three month (T2) follow-ups.

MADRS, HAM-A and HAM-D values decreased significantly at T1 and T2 follow-ups. T0: MADRS 42, HAM-D 33, HAM-A 54; T1: MADRS 18, HAM-D 12, HAM-A 15; T2: MADRS 4, HAM-D 5, HAM-A 10. We also observed an improvement in cognitive test: T0: MMSE 16/30, MoCA test 4/30; T1: MMSE 18/30, MoCA test 6/30; T2: MMSE 20/30, MoCA test 8/30. The patient reported one episode of hypertension treated with clonidine after two moth of treatment, and mild prolonged motor slowing lasting about two hours after esketamine in the first month.

This case documented a successful treatment using intranasal esketamine in combination with an SSRI (Fluoxetine) for an older individual with cognitive impairment and a persistent anxiety-depressive syndrome. This approach was employed as a therapeutic intervention after multiple unsuccessful attempts with other antidepressant medications. Our findings confirmed the safety and tolerability of esketamine in an elderly female with cognitive impairment. Although a minor improvement in cognitive abilities has been noted, secondary dysfunction attributable to vascular-based cognitive decline remained. In terms of cognitive tolerance, derivatives of ketamine could potentially serve as an alternative to electroconvulsive therapy in cases of treatment-resistant depression, potentially improving short-term cognitive outcomes.

None Declared

Depression and dementia with Lewy bodies (DLB) are two fairly common pathologies in the elderly which can have similar presentations or be associated and therefore pose a diagnostic challenge.

We propose to illustrate, through our case, the diagnostic and therapeutic challenge of these two pathologies.

We present the case of Ms. S. BA aged 67, without organic or psychiatric history, admitted to the psychiatry department for massive anxiety and insomnia. The troubles date back to nineteen months when the patient isolated herself, remained bedridden, lost her appetite and no longer slept. The evolution quickly led to the appearance of an excessive agitation. The patient became distracted, talking and laughing to herself, and ran away from the house. She consulted several free-lance psychiatrists and received several antipsychotic medications without improvement. The admission interview revealed a very anxious patient with a difficult contact. Her speech was centred on well-detailed visual hallucinations with themes of death. The neurological examination was difficult at first. She was started on haloperidol and clonazepam. After 2 days, neurological examination showed a parkinsonian syndrome and a temporal disorientation. Other cognitive functions were difficult to assess. The two diagnoses evoked were DLB and a characterized depressive episode with psychotic features. Standard workup showed mild anaemia and thrombocytopenia. Brain MRI and electroencephalogram and immune tests were normal. However, PET imaging was not available in our hospital. Haloperidol was immediately stopped and the patient was treated with an anticholinergic corrector in combination with quetiapine at 200 mg. The evolution was characterized by a significant reduction in anxiety and visual hallucinations with a marked improvement of the parkinsonian syndrome. Depressive symptoms took the forefront of the clinical presentation; hence we associated sertraline with quetiapine. The subsequent evolution showed a clear improvement in the depressive symptoms with total resolution of the parkinsonian symptoms and a normal cognitive evaluation.

In our case, the clinical evolution constituted a key element in the diagnostic orientation. So far, it is unlikely that our patient has DLB and the diagnosis retained was a characterized depressive episode with psychotic and melancholic features. Depression in the elderly can have atypical presentations, and raise the possibly of other differential diagnoses. Diagnostic uncertainty should not delay the implementation of treatment.

The choice of molecules must take into account the associated somatic symptoms for a better tolerance. In the absence of a biological or iconographic examination with good sensitivity and specificity, the therapeutic test remains the only way to decide.

None Declared

tardive dysphoria is a relatively new term used to describe the phenomenon of clinical worsening of depression after long-term antidepressant use. Most of the theories proposed to explain this talk about antidepressants tachyphylaxis that implies the loss of efficacy with its prolonged use, or even a pro-depressant effect of antidepressants when used for long periods of time.

to explore the concept of tardive dysphoria, potential causes and clinical implications, by making a literature review on the topic. Moreover we pretend to understand the challenges in its diagnosis and treatment.

bibliographical search in PubMed database, using the key-words “long-term antidepressant”, “tardive dysphoria” and “antidepressant tachyphylaxis”, limited to works published in the last twenty years.

from our search resulted 53 articles, 26 were chosen for further analysis.

the concept of tardive dysphoria is controversial, namely doubt persists if it constitutes a clinical entity by itself caused by long-term antidepressant use or if it simply relates to cases of treatment-resistant depression. We conclude that it is necessary further investigation in this area given the significant implications on clinical practice specifically in the psychopharmacological treatment with antidepressants, which is very common in psychiatric and general practices, with antidepressants being used to treat many mental health conditions.

None Declared

Esketamine, an active Ketamine isomeric form that indirectly inhibits the GABAergic neuronal pathways, has been recently approved to treated severe, resistant depressive disorders. Here, we present the case of a 64 years old woman diagnosed with severe, resistant depression and an initial score of 28 points in the Hamilton Depression Rating Scale who was treated with Esketamine with excellent response and a HDRS of 8 points after 4 months.

To expose our experience with the first patient treated with Esketamine in our Hospital.

Describing the patient’s patobiography and the different treatments lines tried in first place and exposing the experience among Ketamine treatment and the final results.

We present the case of a 64 years old woman, divorced and retired, who lives with her son since the aggravation of the depressive symptomatology, with no medical nor surgical background and no history in Mental Health before her first psychiatric internment in 2020. Between February 2020 and June 2023, 5 different treatments options with supervise intake were tried, including increment of the dose, antidepressant rotation, the combination of Desvenlafaxine + Mirtazapine and adding Topiramate and Lithium, with no improvement. Among this years, 3 psychiatric internments were needed because of the depressive symptoms and 1 more hospitalization in Internal Medicine was required because of the patients severe, malnutritional state. In June 2023 and after two complete analysis, a MR and a score of 28 points in the Hamilton Depression Rating Scale treatment with Esketamine was started with no incidences. She described one dissociative episode during which she assures “she was surrounded by soft, rubbery, yellow bubbles”. After 4 months of treatment the patient has recovered her previous functional rate and has an 8 points score in the HDRS.

In conclusion, we can affirm that Esketamine is an effective and secure option for Resistant Depresion Dissorder. Nevertheless, Before considering a Depressive Episode as “resistant to treatment”, treatment adherence and other medical, surgical and psychiatric comorbidities must be studied.

None Declared