According to a study by researchers at the Massachusetts General Hospital, individuals who exercise for as little as 30 minutes per day are 17% less likely to suffer from depression.
This is even if their genetics make them more vulnerable to the condition.
Research Paper Title
Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy?
Abstract
Treatment resistance continues to challenge and frustrate mental health clinicians and provoke psychiatric researchers to seek additional explanatory theories for psychopathology.
Because the inflammatory process activates symptoms of depression, anxiety, and psychosis, it is a reasonable route to follow for primary and/or indirect contribution to mental disorders.
The current article reviews the research literature regarding the role the inflammatory process and immune system play in mental disorders as well as novel treatments under investigation for resistant depression, anxiety, substance use, and psychotic disorders.
Reference
Limandri, B.J. (2020) Inflammatory Response and Treatment-Resistant Mental Disorders: Should Immunotherapy Be Added to Pharmacotherapy? Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.11-16. doi: 10.3928/02793695-20191218-03.
Research Paper Title
Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression.
Background
Concerns about ketamine for treating depression include abuse potential and the occurrence of psychotomimetic effects.
This study sought to comprehensively assess side effects (SEs) associated with a single subanesthetic-dose intravenous ketamine infusion.
A secondary aim was to examine the relationship between Clinician-Administered Dissociative States Scale (CADSS) scores and dissociative symptoms reported on a comprehensive, clinician-administered SE questionnaire.
Methods
Data from 188 participants were pooled from four placebo-controlled, crossover ketamine trials and one open-label study (n = 163 with either treatment-resistant major depressive disorder or bipolar disorder and 25 healthy controls).
SEs were actively solicited in a standardized fashion and monitored over the time-course of each study.
Statistical analyses assessed the effect of drug (ketamine, placebo) on SEs and measured the relationship between CADSS total score and SEs contemporaneously endorsed during structured interviews.
Results
Forty-four of 120 SEs occurred in at least 5% of participants over all trials.
Thirty-three of these 44 SEs were significantly associated with active drug administration (versus placebo).
The most common SE was feeling strange/weird/loopy.
Most SEs peaked within an hour of ketamine administration and resolved completely by two hours post-infusion.
No serious drug-related adverse events or increased ketamine craving/abuse post-administration were observed.
A positive correlation was found between dissociative SEs and total CADSS score.
The post-hoc nature of the analysis; the limited generalisability of a single subanesthetic-dose ketamine infusion; and the lack of formal measures to assess ketamine’s cognitive, urological, or addictive potential.
Conclusions
No long-lasting significant SEs occurred over the approximately three-month follow-up period.
Reference
Acevedo-Diaz, E.E., Cavanaugh, G.W., Greenstein, D., Kraus, C., Kadriu, B., Zarate, C.A. & Park, L.T. (2019) Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression. Journal of Affective Disorders. pii: S0165-0327(19)31983-4. doi: 10.1016/j.jad.2019.11.028. [Epub ahead of print].
Research Paper Title
The role of relapse prevention for depression in collaborative care: A systematic review.
Background
Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings.
Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care.
The researchers undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care.
Methods
The researchers searched for Randomised Controlled Trials (RCTs) of collaborative care for depression.
In addition to published material, they obtained provider and patient manuals from authors to provide more detail on intervention content.
They reported the extent to which collaborative care interventions addressed four relapse prevention components.
Results
93 RCTs were identified.
31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention.
30 (32.3%) did not report relapse prevention approaches.
The researchers did not receive trial materials for approximately half of the trials, which limited their ability to identify relevant features of intervention content.
Conclusions
Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk.
Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
Reference
Moriarty, A.S., Coventry, P.A., Hudson, J.L., Cook, N., Fenton, O.J., Bower, P., Lovell, K., Archer, J., Clarke, R., Richards, D.A., Dickens, C., Gask, L., Waheed, W., Huijbregts, K.M., van der Feltz-Cornelis, C., Ali, S., Gilbody, S. & McMillan, D. (2019) The role of relapse prevention for depression in collaborative care: A systematic review. Journal of Affective Disorders. pii: S0165-0327(19)30734-7. doi: 10.1016/j.jad.2019.11.105. [Epub ahead of print].
Research Paper Title
Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis.
Background
Anxiety and depression symptoms are frequently experienced by individuals with psychosis, although prevalence rates have not been reviewed in first-episode psychosis (FEP).
The aim of this systematic review was to focus on the prevalence rates for both anxiety and depression, comparing the rates within the same study population.
Methods
A systematic review and meta-analysis was completed for all studies measuring both anxiety and depression in FEP at baseline.
The search identified 6040 citations, of which n = 10 met inclusion criteria.
These reported 1265 patients (age 28.3 ± 9.1, females: 39.9%) with diagnosed FEP.
Studies which used diagnosis to define comorbidity count were included in separate meta-analyses for anxiety and depression, although the heterogeneity was high limiting interpretation of separate prevalence rates.
A random-effects meta-analysis also compared the mean difference between anxiety and depression within the same studies.
Results
The researchers show that anxiety and depression co-occur at a similar rate within FEP, although the exact rates are not reliable due to the heterogeneity between the small number of studies.
Conclusions
Future research in FEP should consider routinely measuring anxiety and depression using continuous self-report measures of symptoms.
Clinically, the researchers recommend that both anxiety and depression are equally targeted during psychological intervention in FEP, together with the psychotic symptoms.
Reference
Wilson, R.S., Yung, A.R. & Morrison, A.P. (2019) Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis. Schizophrenia Research. pii: S0920-9964(19)30542-0. doi: 10.1016/j.schres.2019.11.035. [Epub ahead of print].
Trauma- and stress-related disorders result from exposure to a traumatic or stressful event.
Specific disorders include acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). These disorders cause similar symptoms but differ in how long they last.
Although depression and anxiety are often prominent, individuals with trauma-related disorders often have a wide variety of symptoms that may not obviously seem related to the traumatic event.
For example, individuals may:
When treating anxiety disorders, there are a number of things to consider:
Accurate diagnosis is important because treatment varies from one anxiety disorder to another.
Additionally, anxiety disorders must be distinguished from anxiety that occurs in many other mental health disorders, which involve different treatment approaches.
If the cause is another medical disorder or a drug, medical professionals aim to correct the cause rather than treat the symptoms of anxiety.
Anxiety should subside after the physical disorder is treated or the drug has been stopped long enough for any withdrawal symptoms to abate.
If anxiety remains, anti-anxiety drugs or psychotherapy (such as behavioural therapy) is used.
For individuals who are dying, certain strong pain relievers, such as morphine, may relieve both pain and anxiety.
If an anxiety disorder is diagnosed, drug therapy or psychotherapy (such as behavioral therapy), alone or in combination, can significantly relieve the distress and dysfunction for most individuals.
Benzodiazepines (such as diazepam) are commonly prescribed for acute anxiety.
For many individuals, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), work as well for anxiety disorders as they do for depression.
Specific treatments depend on which anxiety disorder is diagnosed.
All of the anxiety disorders can occur along with other psychiatric conditions.
For example, anxiety disorders often occur along with an alcohol use disorder.
It is important to treat all of these conditions as soon as possible.
Treating the alcohol use disorder without treating the anxiety is unlikely to be effective since the individual may be using alcohol to treat the anxiety.
On the other hand, treating the anxiety without addressing the alcohol disorder may be unsuccessful because daily changes in the amount of alcohol in the blood can cause levels of anxiety to fluctuate.
A diagnosis of anxiety disorder is via a medical professional’s evaluation, based on specific criteria.
Deciding when anxiety is severe enough to be considered a disorder can be complicated.
Individual ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult.
Medical professionals usually use the following specific established criteria:
Medical professionals look for other disorders that may be causing anxiety, such as depression or a sleep disturbance.
They may also ask whether relatives have had similar symptoms, because anxiety disorders tend to run in families.
Medical professionals also do a physical examination. Blood and other tests may be done to check for other medical disorders that can cause anxiety.
Mental illness cannot always be clearly differentiated from normal behaviour.
For example, distinguishing normal bereavement from depression may be difficult in people who have had a significant loss, such as the death of a spouse or child, because both involve sadness and a depressed mood.
In the same manner, deciding whether a diagnosis of anxiety disorder applies to people who are worried and stressed about work can be challenging because most people experience these feelings at some time.
The line between having certain personality traits and having a personality disorder can be blurry.
Thus, mental illness and mental health are best thought of as being on a continuum.
Any dividing line is usually based on the following:
Research Paper Title
Strengthening resilience in military officer cadets: A group-randomized controlled trial of coping and emotion regulatory self-reflection training.
Background
This group-randomised control trial examined the efficacy of guided coping and emotion regulatory self-reflection as a means to strengthen resilience by testing the effects of the training on anxiety and depression symptoms and perceived stressor frequency after an intensive stressor period.
Methods
The sample was 226 officer cadets training at the Royal Military College, Australia. Cadets were randomised by platoon to the self-reflection (n = 130) or coping skills training (n = 96). Surveys occurred at 3 time points: baseline, immediately following the final reflective session (4-weeks post-baseline), and longer-term follow-up (3-months post-initial follow-up).
Results
There were no significant baseline differences in demographic or outcome variables between the intervention groups. On average, cadets commenced the resilience training with mild depression and anxiety symptoms. Analyses were conducted at the individual-level after exploring group-level effects.
No between-groups differences were observed at initial follow-up. At longer-term follow-up, improvements in mental health outcomes were observed for the self-reflection group, compared with the coping skills group, on depression (Cohen’s d = 0.55; 95% CI [0.24, 0.86]), anxiety symptoms (Cohen’s d = 0.69; 95% CI [0.37, 1.00]), and perceived stressor frequency (Cohen’s d = 0.46; 95% CI [0.15, 0.77]).
Longitudinal models demonstrated a time by condition interaction for depression and anxiety, but there was only an effect of condition for perceived stressor frequency. Mediation analyses supported an indirect effect of the intervention on both anxiety and depression via perceived stressor frequency.
Conclusions
Findings provide initial support for the use of guided self-reflection as an alternative to coping skills approaches to resilience training.
Reference
Crane, M.F., Boga, D., Karin, E., Gucciardi, D.F., Rapport, F., Callen, J. & Sinclair, L. (2019) Strengthening resilience in military officer cadets: A group-randomized controlled trial of coping and emotion regulatory self-reflection training. Journal of Consulting and Clinical Psychology. 87(2), pp.125-140. doi: 10.1037/ccp0000356. Epub 2018 Nov 29.
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