Behavioural Activation for the Treatment of Depression in Military Personnel.

Behavioural activation for the treatment of depression in military personnel.

J R Army Med Corps. 2013 Mar; 159(1): 15-20
Whybrow D

INTRODUCTION: Depression is a common mental health problem in both civilian and military populations. Access to evidence based psychological therapies for treating common mental health problems such as depression may not be adequate at present. Behavioural Activation (BA) represents a National Institute for Clinical Excellence recommended, evidence-based treatment for depression. The aim of this review was to review the literature to determine how BA could work as a therapeutic approach for military personnel with depression. METHOD: Five specialty-specific electronic databases were searched using the key words ‘behavioural activation’, ‘activity scheduling’ and ‘depression’. Emerging themes were drawn out of the literature using a long table approach to thematic analysis. RESULTS: Seven themes were identified: Clinical Effectiveness, Cultural Competence, Co-morbidity, Cost Effectiveness, Alternatives to Face-to-Face Therapy, Training and Patient Experience. CONCLUSIONS: Group based BA is a cost effective option that may build upon service personnel’s cultural affinity to teamwork and peer support. Brief training workshops and supervision could be provided to military mental health nurses to deliver group based BA. However service delivery may also be enhanced by enabling some nurses to specialise as Cognitive Behavioural Psychotherapists. More research is needed to understand whether this pragmatic, two pronged approach to training would result in the sustained dissemination of evidence based practice. HubMed – depression

The missing link: Enhanced functional connectivity between amygdala and visceroceptive cortex in migraine.

Cephalalgia. 2013 May 29;
Hadjikhani N, Ward N, Boshyan J, Napadow V, Maeda Y, Truini A, Caramia F, Tinelli E, Mainero C

BACKGROUND: Migraine is a neurovascular disorder in which altered functional connectivity between pain-modulating circuits and the limbic system may play a role. Cortical spreading depression (CSD), which underlies migraine aura (MWA), induces C-fos expression in the amygdala. The role of CSD and amygdala connectivity in migraine without aura (MwoA) is less clear and may differentiate migraine from other chronic pain disorders. METHODS: Using resting-state functional MRI, we compared functional connectivity between the amygdala and the cortex in MWA and MWoA patients as well as in healthy subjects and in two other chronic pain conditions not associated with CSD: trigeminal neuralgia (TGN) and carpal tunnel syndrome (CTS). RESULTS: Amygdala connectivity in both MWA and MWoA was increased to the visceroceptive insula relative to all other groups examined. CONCLUSION: The observed increased connectivity within the limbic/viscerosensory network, present only in migraineurs, adds to the evidence of a neurolimbic pain network dysfunction and may reflect repetitive episodes of CSD leading to the development of migraine pain. HubMed – depression

Higher pre-treatment 5-HT1A receptor binding potential in bipolar disorder depression is associated with treatment remission: A naturalistic treatment pilot PET study.

Synapse. 2013 May 30;
Lan MJ, Hesselgrave N, Ciarleglio A, Ogden RT, Sullivan GM, Mann JJ, Parsey RV

Bipolar Disorder is a major cause of disability and a high risk for suicide. The pathophysiology of the disorder remains largely unknown. Medication choice for bipolar depression patients involves trial and error. Our group reported previously that brain serotonin 1A (5HT1A ) receptor binding measured by positron emission tomography (PET) is higher in bipolar depression. We now investigated whether pretreatment 5HT1A levels correlates with antidepressant medication outcome. 41 medication-free DSM-IV diagnosed, bipolar patients in a major depressive episode (MDE) had brain PET scans performed using [(11) C]WAY-100635 and a metabolite corrected arterial input function. The patients then received naturalistic psychopharmacologic treatment as outpatients and a follow up Hamilton Depression Rating Scale (HDRS) after 3 months of treatment. Patients with 24 item HDRS scores less than 10 were considered to have remitted. A linear mixed effects model was used to compare BPF (binding potential, proportional to the total number of available receptors) in 13 brain regions of interest between remitters and non-remitters. 34 patients completed 3 months of treatment and ratings; 9 had remitted. Remitters and non-remitters did not differ in age, sex or recent medication history with serotonergic medications. Remitters had higher [(11) C]WAY-100635 BPF across all brain regions compared with non-remitters (p=0.02). Higher pre-treatment brain 5HT1A receptor binding was associated with remission after 3 months of pharmacological treatment in bipolar depression. Prospective treatment studies are warranted to determine whether this test predicts outcome of specific types of treatment. Synapse, 2013. © 2013 Wiley Periodicals, Inc. HubMed – depression